Transcription:
The MASTRS of Motion Tackle Low Back Pain

Scott Webb (Host): Lower back pain is very common, whether it's from injuries, degeneration, or just a lifetime of lifting things, playing sports or whatever the causes and physical therapists can help. And joining me today are Sami Ahmed, Danielle James, Nick Misener and Kyle Pearce and they're all doctors of physical therapy and you can find them all at Mid-Atlantic Sports Therapy and Rehab. Welcome to A Bone To Fix podcast, Masters of Motion Edition, where we're going to focus on the physical therapy side of orthopedics. I'm Scott Webb. So first off, want to thank you all for joining me. This should be an interesting conversation. I'm 53 and my lower back hurts me all the time, but I've never been to anybody, like yourselves to, to have this looked at, to have this fixed.

So, I'm going to pick your brains, take some notes, a little free medical advice for me and everybody else. And as we get rolling here, Sami, let's just talk about this. Who comes to see you when it comes to lower back? What are they complaining of and how do you get things rolling with patients or perspective patients?

Sami Ahmed, DPT (Guest): That's a really good question. You know, here at Mid-Atlantic Sports Therapy, we've kind of have a wide variety of patients that we do see, you know, we get anything low back pain coming from your young 13-14 year old athlete who just lifted too much or pushed too hard during a practice to, you know, someone who potentially may be in their forties, fifties, or sixties, and may have lifted their, you know, son, grandson, et cetera. And kind of just you know tweaked themselves a little bit. It's a common thing, I feel like all of our therapists see. I think the biggest thing though, is that, you know, it's hard to sometimes determine if it was a mechanical loaded strain, what we call it a mechanical low back pain versus it being, you know, a disc herniation.

We're lucky here that we've got such a wide variety of therapists, and our physician cohort that we work so well together with that, we get a little bit of everything. I will say that I think that a large number of our population that we do get to see, does have low back pain. And a lot of times people don't admit that they even have low back pain until it's too late.

Host: Yeah, it does seem like, at least in my case, it's just one of those things that affects my quality of life, but it just seems easier not to go, not to do something about it. And I want to ask, you know open it up to the group. My son had this experience in baseball. You got his back all twisted up in baseball a couple of years ago. And I don't know the name of it. You guys are the experts here, but the little triangle down at the bottom of your back, this is the way my son explained it to me anyway. He's like, yeah, dad. So, I had this triangle thing and instead of being like the right way, it was like turned sideways.

And I said, well, that sounds unpleasant. That doesn't sound right. And he goes, yeah. So, over like five sessions or so the physical therapist is going to work to like turn that thing back the way it should, because he was in such agony, such misery, you know, 18 year old kid could barely walk and within five sessions, he was back to normal and it was totally amazing.

And I was like, wow, the power of physical therapy. So, maybe one of you can tell me, what is that triangle thing? Is that a common injury for athletes and what do you do to help folks like my son who comes in with that complaint?

Kyle Pearce, DPT (Guest): So this is Kyle chiming in here. I'd love to take that on. I have definitely seen in the patients that I've treated a really common feature of that low back is that sacrum. It's the base of our spine below our lumbar spine that often we talk about with disc herniation. But that sacrum, although it is a bone that does not move much between our two pelvis bones, with younger individuals, it does have a little bit of play.

And so whenever we have a lot of force through throwing athletes or acrobatic athletes, you know, and we're talking about trying to improve flexibility in young individuals, as well as maintain strength, they can have this imbalance where that sacrum is pulled to one side or the other, creating a lot of pain.

All of us have reached around to about our beltline, in agony at one point in our life. And, you're actually pointing towards the base of the spine or that sacrum, and it can be a problem. We can do a lot of things with muscle training and manual techniques to try to improve some better balance there.

Host: Yeah, I was really blown away and you're so right. That's what it was. And within a few weeks he was back to normal and playing baseball again, really truly amazing. And my daughter plays a lot of sports. She plays basketball and softball, and so I'm always trying to help her try to sort of prevent injuries. Right? And one of the things I've thought about doing is bringing her to a physical therapist to try to develop a plan, you know, a warm-up plan, a workout plan, something that she can do after, you know, she's played sports.

And I'm wondering if one of you can kind of take us through that, when we think about the lower back and trying to prevent injuries or prevent fatigue, how do you help folks?

Nick Misener, DPT (Guest): Yeah, I can chime in with a couple ideas here. My name's Nick. So, a lot of times there's a dynamic warmup that can help kind of prime an athlete and get them ready for whatever type of activity that is. So, accessing some of their abdominal muscles, we kind of called them like slings or these muscles kind of play together, create some stability in the back and help prevent some of the strain things that can happen when you tend to over exert yourself.

So, as a therapist, what we can see on our side of things is we look for some of those muscle imbalances and we look for movement system impairments, and we see are there certain things that someone's compensating with and maybe they're moving a certain way because of they have more propensity to, to rotate one way. Cause they were right hand dominant, right leg dominant, whatever rotations they might be doing in their sports. And that's where we're trying to exploit, okay, we need to strengthen something else to create a better balance that will help create better stability for them.

Danielle James, DPT (Guest): So, building off, well, first off what you mentioned with your son, how, I guess you had said it was a couple of weeks later, then he went from being in agony. The sooner somebody can get to us after an injury, typically the better prognosis. So, I've had somebody, lift a couch over the weekend, come to me Monday, Tuesday. And by the end of the week, they're 99% better. Versus someone dealing with, like you mentioned 20, 30 year history of back pain that they just kind of live with. And you know, it's not so bad, it might not affect their function. And for my dad, for example, as long as it doesn't affect his golf game, he's not going to come to me for any help.

So typically the sooner somebody gets to us the better. And then, like you mentioned with your daughter from a preventative measure, we're looking at several different things. We're looking at mobility, strength, core stability, motor control. And then what I tend to find is that these young athletes are doing a lot of strengthening for their prime movers, which are those really large global muscles, your glutes, your erector spinae, upper traps, you know, quads, hamstrings, and then we lose a lot of strength within those small stabilizing muscles in the back. So, mechanically speaking, they might be strong, but then their motor control is just terrible. So, we need to kind of pull back on the reins a bit and fine tune movement patterns, and strengthen those stabilizers to prevent injury.

Host: Yeah, that sounds good. It's so funny though, about that, as long as I can play golf, I'm fine. I'm not go in to see anybody if I can still swing in the club. And maybe one of you can take this on and explain to me, sort this out for me in my head. But I remember being at a baseball game and they run these little commercials, little ads for whatever it is, doctors, physical therapists it was so catchy the way it was said. But basically it was something about, if you want to have a healthy back or strengthen your back, you gotta strengthen the front. You gotta work on the muscles in the front to make the back work properly. And I, apologize again, that's not a very elegant way of saying it, but I'm hoping one of you experts here can kind of sort this out for me.

What does that mean exactly. I need to strengthen my core. I need to strengthen my abs in order to have better support from my back. Am I making any sense?

Danielle: Yes exactly. So I like to kind of think and refer this within the PT realm, your core is kind of like a soda can. So, the top part of that can, is your actually your diaphragm. The bottom part of that can, is your pelvic floor. And then the front is your abdominal muscles, a muscle called your transverse abdominis and then the back or your back muscles.

So, you really want good strength within all of those areas. And people don't realize that your diaphragm is a muscle itself. And then from a female perspective, I see a lot of pregnancy and postpartum patients and they suffer from a lot of pelvic floor weakness, which that can cause some low back issues down the road. So, you really want kind of all components of that soda can to be nice and strong. Does that make sense Scott?

Host: It does. It absolutely does. And I wish I could remember exactly how it was said, but I've always gone back to that, that if I, if I wanted to help my old 53 year old back, maybe I could do a few situps or something along those lines. Right? Just strengthen the front, strengthen the back and everything would probably just work a little bit better. And I'm wondering if you guys had this experience where one of the reasons why people put off coming for physical therapy is they've heard these sort of horror stories or nightmare stories of people who've had things like a knee replacement, right? Something really sort of dramatic done, something replaced. And the physical therapy was very difficult on them. And then that's sort of becomes the narrative for people that physical therapy, oh man, they're really gonna put you through your paces.

It's really going to be hard, you know, so maybe you guys can take that on just a little bit, just to sort of dispel the myths when it comes to physical therapy that, you know, you're there to help. You don't mean to sort of, you know, torture people, but at the end of this, if they can make it through their course of physical therapy, their course of treatment, they're going to be so glad that they did right?

Kyle: So, So I'd love to take that one on Scott. It's definitely a misconception that physical therapy all the time has to be this grueling tasking. You know, if somebody is coming in after knee replacement, you'll see them in the clinic next to you and you see them working really hard. But you know, for those individuals suffering with low back pain, you know, you're already in pain coming in. Our only goal is to help reduce that pain and break the pain cycle so that we can introduce safe, healthy exercises that can get you back to moving the way you'd like to. Sometimes that's as easy as beginning with a couple of stretches, getting somebody walking a little bit extra throughout the day and just encouraging overall better mobility and getting people moving again. Decreasing pain, not increasing pain.

Host: It makes me think, you know, how far everything in medicine and science and technology has come, maybe you guys can discuss just the latest and greatest, like what are you guys doing? How are you treating people? What technology or science or imaging, or, you know, just, what are you excited about?

Sami: I think that's really interesting that you said that cause you know, there's an old idiom that says that physical therapy, we really stand for pain and torture. Cause that's really what we do well, right. Is we paint, we bring our patients pain and torture, and I like to think that we actually take our patients out pain and torture, right? We try to get them

Host: I agree. Yeah.

Sami: Technology-wise, you know every day there seems to be a new gadget that seems to be popping into the field, right? From biomechanical analysis software that's coming out. You know, years ago we used to use things when the Xbox one first came out or the 360, there are all these, you know, Biotracers and biomarker tracer technology that came out or EMG processes that came out. Even now we're seeing in the clinic, you know, the physicians that we work with, you know, we have such a great team that we're partnered with that, you know, they're doing these minimally invasive surgeries that are leaving one, minimal to no scarring, and two improving patient functions and outcomes so much quicker, which makes our job in terms of the recovery world better.

And then to be honest, sometimes it's tapping into the old to bring something new, you know, within our own clinics, one of the big things, back toward the eighties, there was a couple of instances where dry needling first kind of came around to the US. It became a hot topic and I'd say, yeah, now we've got what 30, some odd guys, 30, 33 PTs within our practice. And I'd say probably a good 15 or 16 of them are all trigger point, dry needling certified. And it's one of those things that in terms of dealing with back pain, particularly, that is a huge game changer. Right? Cause when you have trigger points deep into that tissue into that fascial layer and you have to get, you know, some of the muscles that Danielle had mentioned earlier, the multifidi, the lumbar paraspinals that are really deep. It's really hard to palpate those. There's not a really good way of getting into that. And so, using trigger point dry needling as a means of treatment methods, I mean, we're seeing patients go from not being able to move one day, to, you know, within a matter of minutes, being able to stand up and walk around again.

I'm not going to lie to you, personally I mean, Danielles on the line right now with us and just the other day I screwed my back up. I was dead lifting at the gym. My QL was on fire and I just looked at her when I walked into the clinic and she said, Sami gets to the back, let's go right now. I'm going to, I'm going needle that for you. And within 20 minutes, I was able to work the rest of the day.

Host: That's so cool. And I want to have one or all of you kind of talk about this, that the nature of what you all do you see a lot of smiles on faces, may maybe not initially, right? But eventually you see smiles on people's faces and I'm sure there's just a high level of satisfaction for all of you in knowing how bad someone was when they came in, even a coworker or a colleague, and then seeing that smile on their face. So, maybe you guys could just talk about that a little bit, just the satisfaction of really being able to help people.

Nick: Yeah. I'd like to talk into that, to start things off, going through physical therapy myself, I tore my ACL when I was 16 years old, playing soccer, went through therapy and saw first hand how rewarding it can be to get someone back to the functional level that they want to get back to. And it's one of the most rewarding things I think that attracts so many people to the profession. During times of COVID, it gets a little bit tough when you can't see someone's smile, you can't really get a sense of how they're doing, but you can hear it in their voice. You can see in their eyes. When they're moving better, they're feeling better. You're making a huge difference in their lives.

Host: Yeah, it's so cool. And just a side note during COVID I've had to teach my kids, my kids are 14 and 19. I'm like, you guys have to learn to smile with your eyes. And they just kind of looked at me like, what does that mean, dad? I'm like, I don't know. But if you're smiling with your eyes, then we can tell you're smiling with your mouths I think. And then they say, dad, you're dumb. You're a boomer. And I move on from there. So, listen, this has been so educational and fun. Want to give anybody who'd like an opportunity, a chance to, you know, final thoughts, takeaways. Think we've learned today, it's best to come in as soon as possible, best to seek a consultation, treatment and so on, but just anybody, your final thoughts and takeaways on how you really can help folks.

Danielle: Yeah, I can jump in on this one. I think, one of the questions just jumping back was about the technologies. I think physical therapy back in the day was very much exercise-based, which it is still is, I mean we want to get people active and moving. And I think our end goal is to get you independent with your program. We don't want you relying on us forever. We want to see you kind of able to manage your symptoms on your own. So, if they do come back, you have those tools and you don't need to rely on us. But the big part of physical therapy is that hands-on treatment, which, you know, it requires a lot of trust in the patient.

We're putting our hands on you and we're using all of these tools within the clinic. Sami mentioned dry needling. We have cupping, we have something called Graston or instrument assisted soft tissue mobilization. It can be aggressive, but I think it just kind of also we listen to the patient, we listen to how their bodies are responding.

I'm not gonna bring my patient to tears most of the time, I won't bring them to tears, but it's, really seeing how they respond to the treatment and modifying and tailoring our treatments to bring them closer to their goals. And, and I develop phenomenal relationships with my patients. I love coming to work.

And I, like you said, it just brings you such joy and satisfaction, getting them to those milestones. I had a patient today who, didn't ever know if he'd be able to swing a golf club again. And he was so overcome with joy, he went out and hit a bucket of balls last night and then said that he wanted to get out and play a round of nine this weekend.

And, you know, it's things that he didn't think he'd be able to do ever, that we're getting him back to doing. And that, the most rewarding part of our job. So, I would encourage people who are struggling with pain, don't be afraid of coming to see us. Don't put it off. The longer you put it off, the more difficult the recovery can be. Not to say that it's, you know, there's not a chance, but it's just going to be a longer recovery process unless you come see us sooner.

Sami: I'd love to add in too that it's we love coming into work. You know, it's not just the patients that we're working with. We collaborate here extremely at Mid-Atlantic Sport Therapy and Rehab a lot together. I mean, me and Danielle have been working together for at least six years now, off and on between different clinics.

Kyle who's on the line. I've known him for over a decade, I was a groomsman in Nick's wedding, not too long ago. And so I've worked with Nick for all six years now. And so looking at that, we're a group that's been around for such a long time in our community that not only do we like to work together, but we share those patient stories. And when we get stuck or we have an issue, we're very, very quick to say, hey, can you collaborate? Can you bring your skill set that might be slightly different than mine to make sure that we bring the best outcomes for our patients? I think that's something that's not really commonly seen.

And with us having so many locations and, we're at six soon to be eight locations now, you know, across the Howard and Baltimore County area and Carroll County as well. It just shows you how strong of a group that we actually have. And to me, that is our biggest strength. It is our strength in numbers and strength in knowledge across the board to help our patients get better.

Nick: Yeah, especially when you're a patient, you have goals and things you want to get back to doing, you're more likely to want to put the work in and get the most out of it you possibly can. I think if people realize like, yeah, this is your life, you got to get back to living it the way you wanna live it. Join us, you know?

Host: Yeah, that's awesome. And I can totally hear in your voices, how much you all enjoy working with each other, being around each other, supporting, helping each other, working to solve, you know, mysteries with patients and clients. So, this has just been really fun, really educational. When I saw that I was going to have four of you on, I was like, how am I going to do this?

How am I going to manage this? But this worked out great. I think probably a testament to how just well you all work together. So, thank you all you all. And to find out more about us online at mdbonedocs.com. We have six PT locations for your convenience and more to come. And please remember to share and subscribe to this podcast.

That's all for today. I'm Scott Webb and that was A Bone That's Fixed.