Jill’s Journey Through Back Pain: A Case Study Part I

Who Is Jill?

When Jill first presented to the Wellness Station, she described her life as “a mess” and felt skeptical that another attempt at physical therapy would make any kind of difference. Jill is 75 years old and had stayed generally active with outdoor rowing and exercising with weights. However, Jill has experienced recurrent bouts of debilitating back pain over the last 15 years, which tended to set her back for quite some time. She had been to physical therapy several times, which never made any long-lasting difference for her.

Jill was having an extremely challenging year. She had become more sedentary during the pandemic, as she did not feel as comfortable working out with her personal trainer. She lost her husband, her lifelong best friend. On top of this, her sister also lost her husband around the same time.

While at her sister’s house to support her both emotionally and physically and to re-organize their house, Jill suffered a severe back injury. A herniated disc in her lumbar spine became sequestered, and the sequestered disc fragment led to nerve compression. Jill began to experience severe back and leg pain, which was constant and severe. She had herniated several discs in the past, and she described this pain as far worse.

Jill went through a course of traditional physical therapy and described it as follows:

““It was very modest stuff. I felt like there wasn’t much of a progression, and it wasn’t as individualized as I would have hoped. They might have used the same printable exercises as any other old lady with back pain!” ”

Jill Finds The Wellness Station

Jill was referred to the Wellness Station four months after her sequestration injury, and was still experiencing constant, debilitating pain. In coming to the Wellness Station, Jill hoped for improvement but wasn’t sure what to expect. Her goals were to improve her fitness and build her core strength in order to be active, independent, and play with her grandchildren- however, she was beginning to lose hope that any of this would be possible.

““In the first session, I found Jacob Tyson to be an exceptional listener as I outlined my back pain history, the recent event and goals. The room was calm as was his demeanor that set a relaxed tone.””

““I still was puzzled in the first few sessions that focused on just a few movements or exercises to establish what is called the pelvic clock. But at each weekly session, the new movements built on the previous week, a method I could appreciate as a former newswriting instructor, teaching the basic journalism language and incorporating more concepts and practices as students learned newswriting style.” ”

Jill Turns the Corner, & Beyond! 

As we worked together over the course of weeks to months to a year, we gradually progressed Jill’s home exercise program by introducing new movements, slightly more challenging than the week before. We continued to layer on educational and lifestyle components that were related to Jill’s life, including concepts of biomechanics, anatomy, exercise physiology, psychology, mindfulness, pain neuroscience, and more.  As Jill continued to learn and build her strength and confidence, she has been able to do more demanding physical tasks without any increase of pain.

“ “Through the sessions, I learned how to stand up and walk in new ways, to use my legs and tailbone to shift weight, to improve the flexibility of my entire spine—all aimed at relieving the pressure and weight on the lumbar part of my spine. We also did relaxation and simple meditation to promote mind-body connection. After each session, I received an email, summarizing our activity. I have compiled all those exercises and support into a file that I can use to refresh my memory of exercises—and to see my progress.” ”

““The knowledge and movements I learned gave me a feeling of accomplishment and control over the mechanics of my body. Usually an exercise or stretch would relieve the pain, and I did not take any medication. A triumph!” ”

Jill is doing much better today, and feels that she has gotten her life back. She no longer feels limited by her pain, and feels empowered to stay active and engaged in life. She is now back to rowing (weather-permitting!), going to the gym twice per week, and having no trouble lifting her quickly growing grandchildren!

Jill also improved on the Modified Oswestry Disability Index (a survey used to measure the impact that back pain has on quality of life) from a 58% to a 12% over a period of six months, which is over four times the threshold of clinically significant improvement. 

Stay tuned in to see our next blog post, which will break down more specifically what we addressed with Jill biologically, psychologically, and socially.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

https://www.safetyandhealthmagazine.com/ext/resources/images/2019/10-oct/back-pain.jpg?t=1568903562&width=768

http://balanced-movement.com/2019/02/17/controlling-pelvis-hips/

https://media.istockphoto.com/id/1386275231/vector/the-adventure-of-a-young-woman-kayaking-with-her-backpacks-and-equipments.jpg?s=612x612&w=0&k=20&c=uMr4W4mhhuTzv00gKpPztNoIi_w7v9H05NYDUOiQydA=

Yoga: Like Flossing for your Joints!

For our whole lives, we participate in a daily practice to ensure the health of our teeth, as it is obvious that tooth decay is extremely undesirable. Neglecting dental hygiene can lead to issues far beyond affecting that beautiful smile on your face, including infection, as well as compromised gut and heart health. In order to ensure dental health, we brush and floss daily, and visit the dentist two times per year. We have accepted this as the gold standard practice, and dental hygiene becomes almost an unconscious part of our lives.

What about our joints? We have over 200 of them in our body, and without them, we would be unable to move. Each of these joints desperately need movement, compression, and relaxation in order to stay healthy, mobile, and well-lubricated. Unfortunately, we have an epidemic of poor joint health that is on the rise. In fact, around a quarter of US citizens have arthritis (an inflammatory disease of the joints), and the prevalence of knee osteoarthritis has actually doubled since the mid-20th century.1 This is contributing to extreme rises in healthcare costs, risky surgeries, chronic disability, and unnecessary pain and suffering. Poor joint health is also associated with many other health conditions- depression, cardiovascular disease, stroke, and metabolic conditions such as diabetes.2 There are many theories as to why the incidence of this disease is so high- increasing weight, sedentary behavior, as well as the overall aging of our population. However, there is little discussion about how to address the root cause of this disease through education and prevention.

Why is there not more education about how to keep our joints healthy as we go through our lives? My main takeaways from gym class growing up were pretty much as follows: how many sit ups and chin ups can I do in a minute in order to "perform well" on the presidential fitness test, as well as how quickly can I run a mile in order not to embarrass myself around my peers? However, there was absolutely no discussion of joint health in any of my education up until physical therapy school.

What joints need is movement- movement that goes behind repetitive gym exercises, walking, and running. As joints do not have great blood supply, they are completely reliant on us moving our bodies through our given ranges of motion in order to distribute the lubricating synovial fluid around the joint space. As we move and load our joints through their given ranges of motion, we develop an improved mind-body awareness that helps us control the force we put through each joint through our body's posturing and muscle recruitment/relaxation. By regularly moving each joint, we also build up our injury resistance to both chronic and acute injuries. For example, if you never practice moving your ankle inwards, and then you accidentally trip over a root during a hike that forces your ankle into an inward position, you will be far more likely to sprain this joint compared to someone who regularly practices moving and loading their ankle in this position.

One might be thinking…."Are you telling me that in order to have to have healthy joints, I have to move each and every one of them every single day?? This sounds like a lot of work… I already have enough on my plate, especially with how often I am supposed to floss my teeth!"

Luckily, even a brief mindful movement practice such as yoga can help ensure your joint health! A yoga practice has the potential to move every joint and engage every muscle in your body in a relatively short, continuous sequence. And, you will naturally start to use what you learn on the mat in your daily life as well, perhaps without even meaning to! Rather than a chore, a yoga practice can be fun, and make you feel more comfortable and strong in your body. Yoga can be an excellent supplement to whatever else is in your fitness routine that can actually improve your performance in other athletic endeavors as well.

Written by: Jacob Tyson, DPT - Physical Therapist and Yoga Instructor

References:

1. https://www.pnas.org/content/114/35/9332

2. https://pubmed.ncbi.nlm.nih.gov/31207113/#:~:text=The%20key%20comorbidities%20associated%20with,to%20have%20other%20chronic%20conditions.

Overdoing: To Do or Not To Do?

We live in a culture that is “go go go”, where we prioritize doing far more than not doing. Many of us juggle excessive work hours, family and household responsibilities, hobbies, fitness and wellness practice, social lives, errands, appointments, and more. We are often left with little to no down time, and when we do have this down time, we may spend it in ways that are less than ideal for restoring balance and peace back into our lives. This constant rush can be stressful and taxing on our bodies and minds, and due to time constraints we begin to have to pick and choose what we do. Self-care and sleep may be underprioritized, setting us up for burnout.

Think about yourself as a tea kettle: a 100% full tea kettle means you are in a state of optimal health, energy, comfort, peace, happiness, and overall well-being. The less tea you have in the kettle, the less bandwidth you have, which can manifest in irritability, exhaustion, reduced performance, as well as mental and physical health challenges if this continues over time.

If our goal with the “go go go” mentality is to achieve and succeed, but this mentality actually can set us up for failure over the long term, isn’t this entirely counter productive?

Think about what sources in your life are draining your tea kettle, and what sources are helping to fill up your kettle. Consider both external and internal factors. External may be people, situations, and activities, whereas internal may be thoughts, beliefs, behaviors, emotional reactivity, and movement patterns. What changes can you make in your life to ensure you have a full kettle? After all, an empty kettle serves no one!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

You Can Break the Cycle of Chronic Pain!

It’s All In Your Head: Your Brain & Pain

Many of us who experience pain might feel very offended if we were told that this pain was all in our head. However, all pain, as well as any other sensation, is created by the brain. This is because pain is a perceptual process- the experience of the pain is not actually happening in the part of your body that hurts, but rather it is happening in your brain. Sometimes this perception of pain can be a very useful process (Ouch, I just touched a hot stove, let me move my hand away as quick as possible!), but when it comes to chronic pain, this process can severely impact our quality of life.

In cases of chronic pain, the brain tends to get hypersensitized to the pain until we are in a constant state of high alert. A learning process occurs in which neural pathways involved in pain perception of a certain area (the low back, for example) become strengthened. The neural pathways responsible for chronic pain experience go far deeper than our acute pain pathways, such as in the stove top example. This is because over time, the neural pathways related to the chronic pain will be embedded into the memory and emotional centers of our brain, making chronic pain far more complex than pain from acute injuries.

As with any learning process, we form associations, such as... sitting = pain, long car rides = pain, exercise = pain. These associations can contribute to a self-perpetuating cycle in which we avoid certain activities because of the fear of pain, which decreases our quality of life, thereby contributing to depression, inactivity, limited social participation, and other factors that will actually make our pain worse over time.

How do we break this vicious cycle?!?

Pain is our brain's opinion of how much danger we are in, and we have to change that opinion. Our brain was capable of establishing these detrimental neural pathways that contributed to the chronic pain, and it is just as capable of creating new pathways that will help us get out of this situation. This is because our brain remains plastic for our entire lives, meaning we are always capable of learning. We must learn that we are safe, and that movement of the affected body part is safe and beneficial.

At The Wellness Station, we help those in chronic pain learn that they are safe.

By creating individualized movement programs, we help our clients learn ways of moving and relating to the body in a manner that will drive neuroplasticity. We will help to teach the little person in the control room (aka your brain) that movement can be associated with calm, pleasure, and ease, rather than movement = pain. The movements lessons are designed to help our clients move with greater efficiency to make movement easier and to decrease tension and tissue strain. We will also help with self-care tools necessary to calm down the nervous system to decrease pain sensitivity, and provide guidance regarding management of the psychosocial aspects of living chronic pain.

Do not let pain stop you from living life to the fullest. It is never too late to learn!

Written by Jacob Tyson, DPT - Physical Therapist,Yoga Instructor and The Wellness Station Team

Core Strengthening: The Wellness Station Way!

What is our core, what does it mean to have a strong core, and what are the best methods to achieve this?

Many of us associate the idea of having a strong core with the ability to stay active and independent as we age, maintain our balance, avoid injury, ease back pain, or perhaps maintain a trim waistline.

Although the idea of core strength is popular and highly sought after, what we are really after is core responsiveness: how efficient and with how much precision are our core muscles able to respond to the needs of our environment and our intentions. In other words, how well are our bodies able to do what we want them to do in a given situation?

This responsiveness depends on our neuromuscular system- the intricate connections between our brain, spinal cords, and muscles. It is crucial that this responsiveness includes all of the tiny muscles that connect each of our vertebrae, which are vital for dynamic stability, proprioception, and the ability to "change shapes" depending on the needs of the situation.

In the world of traditional physical therapy and fitness, the idea of core strength is often reduced to "core stability", and focuses on the ability to brace and hollow the abdomen. The general notion is that we must be able to keep our core very tight and rigid during movement, lest we injure our spines. This rigid stability utilizes the large, long muscles that travel up and down the spine, neglecting the tiny muscles in between each vertebrae. This is not how we function as human beings!

As we live in a three-dimensional world, our bodies need to be able to efficiently change shapes based on the situation we are in. By only training ourselves to keep our cores tight and thus restricting movement, we are behaving in a linear manner that is not conducive to our dynamic, three-dimensional world. Although this type of core engagement can be helpful in some situations (perhaps if a pet or a baby decided to crawl on our stomach!), far more often this approach is selling ourselves short and could actually put us at a higher risk of injury, pain, or limited function.

   Consider the example of a stack of blocks connected by elastic bands as referenced in our Ehlers Danlos blog post, illustrating the difference between segmental vs. rigid core responsiveness. The traditional approach to core stability is similar to the example in which the blocks are connected only by four long rubber bands, in which the vertebrae (like the tower of blocks) are undifferentiated and controlled using the large, long muscles of the spine. This would neglect the small muscles of the spine that allow us to move with efficiency, fluidity, and balance. Our approach at The Wellness Station reflects the example in which the tower is connected by smaller rubber bands in between each block, allowing the structure to form a variety of complex shapes and forms, representing segmental spinal responsiveness.

Our core is our spine- we need to be able to move our spine in the three dimensions. Flexion and extension, side bending, and rotation. Each of our many vertebrae are capable of movement, and our deep spinal muscles (including the transversospinales and the segmental muscles) allow this movement.

By engaging in mindful movement practices to target these muscle groups, we can strengthen our mind-body connection to these areas, thereby improving responsiveness of our core.

This is truly what core strength is- our ability to move our spines into different shapes efficiently, mindfully, and powerfully depending on our intention and the circumstance we find ourselves in.

Here are some examples of mindful movement drills that engage the body in three-dimensions, and target segmental movement of the spinal column. Enjoy!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team