Bill Klaproth (Host): Physical therapy for spine and neck conditions are an important part of rehab and pain management, and here to talk with us about physical therapy for the spine and neck is, Frank Moreno, a physical therapist at Tidelands Health. Frank, thanks so much for your time today. So, for what types of spine and neck conditions is physical therapy called for?

Frank Moreno (Guest): Thanks for having me on. Well, physical therapy covers kind of a wide variety of spine and neck conditions, anything from arthritis to general aches and pains, to things like sciatica or radiating pain from the neck into the arms or the back into the legs. Many of those conditions can be treated with physical therapy effectively.

Bill: So, arthritis, aches and pains, sciatica, and I would imagine injury too, right?

Frank: Yeah, of course.

Bill: So, then who is a good candidate for spine and neck Physical therapy for someone that does have arthritis or general aches and pains, how do you diagnose, and then say, "You know what this person would benefit from a physical therapy plan."

Frank: Well, most patients could benefit from some form of physical therapy. Of course, anybody with some red flags that have a trauma or maybe experiencing some advanced conditions, which may indicate a higher level of care, we would refer back to the doctor, but how we kind of evaluate that is, we'll take a brief maybe 10 to 15-minute history, ask some questions, and kind of get the patients kind of general response to what types of things trigger their pain. What makes it worse? What makes it better? And what I find in my practice is a lot of these conditions, they are responsive to mechanical forces, where some sort of sitting posture or repetitive movement or some form of activity is likely to provoke or worsen the pain where other activities may lessen, and those types of patients are definitely great candidates for physical therapy.

Bill: So, when you say 'Mechanical' I'm thinking of a person slouched down working in the cubicle in the chair all day, and all that texting that we do, right? The head down texting. Are you seeing a lot of that?

Frank: Absolutely. I think we used to see most back injuries, most neck injuries were trauma related or your typical laborer that would hurt themselves lifting or twisting, but now a lot of what we see are posture related, people that spend too much time on their mobile devices, head down, working in that cubicle sitting for hours at a time. I think that's predominantly what we're seeing more of these days.

Bill: So, then tell us about your treatment and your physical therapy plan. How do you put that together?

Frank: I would typically bring a patient in and ask them a structured series of questions, and try to determine what is the root cause of that pain. Is it every time I sit down I have pain that radiates into my leg or every time I look down or I turn to the right, I have pain that generates in my neck and then maybe travels into my shoulder? Those will give me some clues as to what to look for, and then the next step with that would be to put the patient through some test and movements, and those movements will usually tell me, this pain is being provoked or this pain is being lessened or even centralized, and that will give me a great indication of what I call directional preference, and if I find that a lot of times, we can find relief for patients, sometimes pretty rapidly.

Bill: So, in that relief, what types of treatments do you use?

Frank: Most of my treatments are revolved around the Mackenzie method, and they usually involve having the patient perform one exercise of a repeated movement, whether that might be a neck extension or retraction movement or a back extension or even a side gliding type of movement. But generally, it's an exercise that I can teach the patient how to do correctly, and send them home to do a certain amount of time to monitor the response, but another big part of that is getting them to avoid those activities that are likely to make their pain worse, and a lot of that is correcting sitting posture, correcting behaviors and habits, that have probably gotten them into trouble, and brought them into the office in the first place.

Bill: Right, making the person understand when your head is down or when you're sitting in the chair working, your slouched over. So, you've got to remember that, right? And trying to get the person to actively think, "Okay, got to keep my posture good, my head up." So, obviously that's an important step, and then you said, "The kind of the home therapy," how important then is it that that person takes that home therapy and really sticks to the exercises that you give them?

Frank: Well, that's really crucial in recovery. I always tell my patients I might see you for 45 minutes to an hour, maybe two to three days a week, but you're at home those other 23 hours a day outside of this office, and a lot of the magic happens at home, what you do to correct, and the exercises you perform, and the activities that you avoid, they all play a factor and they're probably even more important. My job really is to guide the patient and coach them and to teach them the right things to do, and it's really their responsibility to fix themselves.

Bill: Right the magic happens at home, I like that. So, how do you measure progress, and at what point does a patient stop coming in to see you for therapy?

Frank: Well, we measure progress in a number of different ways, and it's dependent on the patient's condition, typical sciatica type patient, if that pain is radiating down into their thigh or into their calf and I give them a certain exercise to do and they come back, and they say, "Hey, that pain is no longer in my calf I feel it may be up high in my thigh or in my back." That'll tell me that pain is reducing and centralizing, coming back towards its source, and that's one measure of progress. Another may be that their posture is improved or their leg strength or arm strength is improved or the range of motion of their back and neck has improved. There are a lot of ways to kind of measure progress that way, but I think most importantly what the patients are concerned with is overall pain level, and that's probably the most, the biggest indicator of progress and success.

Bill: Right, that pain level such an important factor, and generally, Frank, how long does someone see you? Is it a month, is it two months, in general?

Frank: Well, I would say, probably on average anywhere from four to six weeks, and we've had some cases where we really hit the nail on the head the first day, and I've had patients that I've seen as little as three to four visits, that have come from pain to complete resolution and been able to be independent and maintain themselves in that short of a period of time. And of course, I've had other more complicated cases that have that have taken longer than that as well.

Bill: So, do you have any quick tips for us that will help us break the bad habits that create neck pain?

Frank: The biggest thing is correct your sitting posture. We find that that's probably the number one thing that really gets people into trouble is people that work on computers or at their desk or looking down at their phones, you really need to bring everything up to your eye level, sit all the way back in your chair, back against the back of the chair. Butt all the way back, 90-degree angles between the shoulders, the hips and the knee. And you really need to bring your computer, your keyboard all that stuff closer to you because you don't want to be where your arms are outstretched reaching for your mouse or typing on your computer that way. And the other thing is to avoid repetitive bending, and repetitive forward head postures, those things are likely to get you into a lot of trouble.

Bill: So, as you are giving us those great tips I'm doing that right now. Okay, need to work on mine.

Frank: I think I'm guilty of that as well.

Bill: And, Frank, why should someone choose Tidelands Health for their spine and neck care?

Frank: Well, I think at Tidelands Health, we have a great team of very highly skilled therapists, and we just have a great system of one-on-one treatment. We are not like a lot of other typical therapy offices. We spend 45 minutes at least, hands-on, one-on-one with each patient, giving them every little bit that they need. And with all the therapist that I work for they really, they go all in, they pay attention to every little thing that's going on with their patients, they're invested.

Bill: Well, a personal touch is so important, Frank, thank you again for your time today. For more information about Tidelands Health Physicians, services and facilities visit, TidelandsHealth.org. That's TidelandsHealth.org. This is Better Health Radio. I'm Bill Klaproth, thanks for listening. All right, Frank, thank you very much.