Shoulder pain is an extremely common complaint. Up to 26% of the population is currently affected by it, and it ranks third—behind back pain and knee pain—in musculoskeletal conditions that lead people to consult their doctor. About 1% of the population visits a doctor for shoulder pain each year, and while the specific backstory may vary from patient to patient, most cases follow a relatively similar progression.

The causes of shoulder pain can generally be categorized into two groups: 1) traumatic (acute) injuries that damage certain structures of the shoulder immediately, and 2) overuse injuries, which occur gradually over time due to continuous strain on the shoulder. In both cases, those who are most likely to experience shoulder pain are individuals who regularly perform overhead movements. These types of movements are necessary in professions like painting and construction, and in sports like baseball, swimming, and tennis, making those who are involved in these activities vulnerable to several types of shoulder issues.

Any component of the shoulder can be damaged in an acute or overuse injury, but most shoulder conditions—about 85%—involve the rotator cuff. The rotator cuff is an important group of four muscles that surround the bones of the shoulder. Each of these muscles spans from a different part of the shoulder blade (scapula) to the head of the upper arm bone (humerus) to form a “cuff” that controls and stabilizes the shoulder. Several problems can affect the rotator cuff or other structures within the shoulder to cause pain, stiffness, or other symptoms that lead to movement restrictions and activity limitations. To help you get a better sense of what can go wrong, here are six of the most common conditions that affect the shoulder:

6 most common shoulder conditions

• Shoulder bursitis: a bursa is a fluid–filled sac that acts as a cushion to prevent structures from rubbing against each other; the subacromial bursa in the shoulder is the largest bursa in the body, and when it becomes inflamed—often from regularly performing too many overhead activities—the result is shoulder bursitis; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Rotator cuff tendinitis (shoulder tendinitis): the most common cause of shoulder pain, this condition results from irritation or inflammation of any of the rotator cuff tendons, which occurs gradually over time; the main symptoms are pain and swelling in the front of the shoulder and side of the arm, usually while raising or lowering the arm
• Shoulder impingement syndrome: a condition in which the bursa or any rotator tendons are trapped (or impinged) by the two main bones of the shoulder—the humerus and a piece of the scapula called the acromion—which is usually due to an outgrowth of bone (bone spur); symptoms include shoulder pain and weakness, and difficulty reaching up behind the back
  • Note: Over time, shoulder impingement can lead to shoulder tendinitis and/or bursitis, and in some cases the names of these conditions may be used interchangeably
• Rotator cuff tear: this injury is the result of one of the rotator cuff tendons detaching from the bone, either partially or completely; it can occur either traumatically due to a single incident, or gradually over time, which is usually the case in older patients; the most common symptom is pain during the day and at night, and when lying on the shoulder or lifting or lowering the arm
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, another structure that helps to keep the shoulder stable; this causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room for the shoulder to move normally, eventually causing it to “freeze;” symptoms include pain and stiffness that makes it difficult or impossible to move the shoulder
• Shoulder dislocation: an injury in which the ball of the shoulder (humerus) pops out of the socket (glenoid); this is typically due to a forceful motion, and the dislocation can be either partial or complete; symptoms include pain, swelling, and difficulty moving the shoulder

Understanding red flags that could suggest an underlying problem

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. However, in rare cases, patients with certain urgent or severe conditions will require the care of another healthcare provider. To help you determine whether seeing a physical therapist is the right call, here are some potential red flags to be aware of if you’re dealing with shoulder pain:

• Deep, intense pain
• Pain associated with unexplained weight loss and/or fever
• Constant pain, including pain at night when the shoulder is at rest
• Signs of infection or septic arthritis (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Severe trauma to the shoulder that may have resulted in a fracture or dislocation
• Known or suspected cancer (eg, significant bone pain, which may be suggestive of a bone tumor)
• Persistent swelling and pain without any recent injury
• Severe muscle spasm

If you notice any of these red flags, see your primary care physician as soon as possible or—for traumatic injuries—go to the emergency department or urgent care clinic immediately. But in the absence of any red flags, we strongly recommend seeing a physical therapist for your shoulder pain as soon as possible to get started on a comprehensive treatment program that will help you regain your abilities over time.

In our next post, we’ll provide three of the best exercises to help keep your shoulders strong and reduce your risk for pain.

Myofascial pain syndrome and dysfunction of the muscles that support the upper spine and shoulders can lead to a variety of symptoms in these regions, including neck pain. The reasons neck pain develops are complex and often difficult to pinpoint, but research has shown that posture and muscle activation patterns are potential risk factors.

Patients with chronic neck pain—meaning pain lasting more than three months—have been found to display differences in the way muscles like the trapezius, levator scapulae, and rhomboids behave. These patients also have less muscle strength and activity than healthy individuals. Therefore, exercises that strengthen and stabilize these muscles to regulate their activity are recommended for patient with chronic neck pain, but the amount of research on this topic is limited. For this reason, a study was conducted to evaluate the effectiveness of various strengthening and stabilization exercises for patients with chronic neck pain.

Three groups of patients assessed before and after 6–week interventions

For the study, patients with neck pain for at least three months were recruited and screened to determine if they were eligible. This led to 72 patients being included, who were randomly assigned to one of three groups: the neck exercise training group, combined training group, or the control group. In the neck exercise training group, patients completed a training program under the guidance of three physical therapists 3 days per week for 6 weeks, with each session lasting 40–60 minutes. The program consisted of three strengthening and stretching exercises that targeted the muscles of the neck.

In the combined training group, patients completed the neck exercise training program plus a scapular stabilization training program. The scapular stabilization training program included 7 strengthening and stretching exercises that targeted muscles in the scapular region that are associated with chronic neck pain.

Patients in the control group participated in a session in which they were taught a home exercise program that mainly instructed them on proper body posture for daily activities like lifting, pressing, and pulling tasks, as well as office ergonomics. All patients were assessed before and after completing these interventions with various outcome measures, including pain, neck range of motion, scapula downward rotation index (SDRI), and forward head angle (FHA). SDRI and FHA are used to assess posture and muscular dysfunction in the upper spine and torso region.

Results showed that pain, SDRI, and FHA decreased in both the neck exercise training group (except SDRI) and combined training group. Neck range of motion also increased significantly in the combined training group. Overall, patients in both the neck exercise training group and combined training group improved compared to the control group, but the combined training group reported significantly greater improvements than the neck exercise training group. Therefore, this study suggests that both neck exercises and scapular stabilization exercises is beneficial for patients with chronic neck pain, and combining these two interventions can lead to even greater benefits in pain, flexibility, and posture.

If you’re dealing with myofascial pain syndrome, chronic neck pain, or any other movement–related issues, we strongly urge you to consider scheduling an appointment with one of our physical therapists, who can diagnose your condition and get you started on a comprehensive rehabilitation program right away.

As we’ve explained, myofascial pain syndrome is one of the most common musculoskeletal conditions, with up to 85% of the population likely to be affected by it at some point. If symptoms arise—which are most likely to be noticed in the mid‐to‐upper spine—it can have a range of negative repercussions, including decreased work capacity, impaired sleep quality, and a worse overall quality of life.

Regularly performing the exercises that we described in our last post will undoubtedly reduce the risk for myofascial pain syndrome in the upper spine, but symptoms may still occur, since numerous factors contribute to the development of this condition. If you notice signs or symptoms of myofascial pain syndrome (eg, deep aching, throbbing sensation, tightness, or stiffness at or near tender trigger points in the upper spine), we strongly recommend seeing a physical therapist as soon as possible. Physical therapists utilize a variety of interventions that are all intended to alleviate pain and improve physical function.

One intervention called the pressure release technique is one of the most recommended manual therapies for myofascial pain syndrome in this region. It involves the therapist applying pressure to the upper spine for 30, 60, or 90 seconds with the goal of immediately relieving pain; however, the effect of each of these durations has not yet been studied. Therefore, a study was conducted to determine which duration of the pressure release technique is best for patients with myofascial pain syndrome.

60 patients randomly assigned to one of three groups

Researchers recruited patients to participate in the study who were aged between 18–40 years and who had at least one myofascial trigger point in the levator scapulae. This led to 60 patients being included, who were randomly assigned to one of three groups. Patients in each group underwent the pressure release technique to the levator scapulae, but the duration lasted for either 30, 60, or 90 seconds. This technique was applied with the physical therapist’s thumb or index and middle fingers directly over the myofascial trigger point, and the amount of compression was increased when the therapist felt a reduction in the resistance of the underlying soft tissues. All patients were assessed for their threshold for pressure pain, strength, neck range of motion, and stretch pain intensity immediately before and after the intervention.

Results showed that the pressure release technique led to several improvements at each of the three durations. However, comparing these values showed that the improvements were greatest in the 90‐second group, followed by the 60‐second group, and finally the 30‐second group. Most notably, patients who underwent the pressure release technique for 60 or 90 seconds experienced significant improvements in both strength and the threshold for pressure pain. This study suggests that just one manual therapy technique frequently used by physical therapists can lead to significant benefits for patients with myofascial pain syndrome.

In our next post, we’ll look at another study that highlights how various exercises used in physical therapy can also help patients with issues in the mid‐to‐upper spine.

As we explained in our last post, myofascial pain syndrome is a common condition that can affect any muscle in the body, but the muscles of the upper back, neck, and shoulder are most likely to be involved. The deep, aching pain and stiffness that results from the characteristic trigger points of myofascial pain syndrome often then go on to impair one’s mobility and degrade quality of life in the process.

One of the best ways to avoid myofascial pain in these regions is to keep the muscles of the trunk and upper spine strong and flexible. To accomplish this, we recommend regularly performing exercises that target these problematic muscles, which will help to reduce the risk myofascial pain and alleviate pain if it does develop. Here are our top 4 exercises for preventing myofascial pain:

Our top 4 exercises for myofascial pain

To see videos of each exercise, go to www.MyRTR.net and enter prescription code 9ZWVZRK8

1. Seated trunk rotation
   • Sit in a chair with one arm over the backrest
   • Reach across your body and grasp the back of the chair with your opposite arm
   • Slowly rotate your trunk until a stretch is felt
   • Hold the stretch for 10 seconds
   • Complete one set of three repetitions, every other day
2. Seated spinal flexion/extension
   • Sit in a chair with your hands behind your head and back straight, and feet slightly wider than shoulder-width apart
   • Slowly bend forward, starting at the waist and gradually bending upper trunk and head toward the floor
   • Return to an upright position, leading with the head
   • Hold the stretch for 10 seconds
   • Complete one set of five repetitions, every other day
3. Rhomboid stretch
   • Sit toward the middle or edge of a chair
   • Bend forward and grasp the opposite side of the leg of a chair with your hand
   • Keep your arm straight and slowly raise your body up while maintaining a grasp of the chair leg
   • Hold when you feel a comfortable stretch for 10 seconds
   • Complete one set of three repetitions, every other day
4. Levator scapula stretch
   • Place one hand on the back of your neck and the other hand on top of your head
   • Sitting tall, use the hand on top of your head to pull your chin toward your armpit until a comfortable stretch is felt
   • Hold for 30 seconds
   • Complete one set of three repetitions, every other day

In our next post, we’ll break down a study about a hands-on technique for myofascial pain.

The spine is possibly the most problematic area of the body. From the base of the spine up to the upper back and neck, there are various ways in which pain can manifest and produce disability. Although pain is most common in the lower back, several issues may cause bothersome pain in the upper spine as well. The most common of these is a condition called myofascial pain syndrome, which is closely related to rhomboid trigger points and levator scapulae pain.

Fascia is thin, connective tissue that surrounds and connects every muscle in the body. Fasciae (plural of fascia) hold muscles together and allow them to stretch and contract smoothly, without creating any friction that can damage the muscles. This explains the root word “fascia” in myofascial pain syndrome, whereas “myo” refers to muscles the muscles that these fasciae connect.

Common sites of myofascial pain

Myofascial pain involves triggers points, which are areas of tenderness and stiffness within muscles and fasciae that reduce range of motion. These trigger points are essentially muscle fibers that are stuck in contraction, which causes the muscle(s) to tighten and eventually prevents blood from flowing to the area. Trigger points feel like small bumps or knots when touched, and when enough of these occur in a certain area, the result is myofascial pain. Trigger points—and resulting myofascial pain—can develop in any muscle of the body but are most common in the upper back, shoulders, and neck, especially the following muscles:

• Trapezius: the trapezius is a large, broad muscle shaped like a triangle that extends from the base of the skull to the middle of the back; it helps give you the ability to tilt and turn your head and neck, shrug and stabilize your shoulders, and twist your arms; the upper trapezius is one of the most common sites for myofascial pain because it takes on a significant amount of pressure, especially when carrying items
• Levator scapulae: this is a long and slender pair of muscles shaped like straps that run from the top of the spine to the top edge of the shoulders; the main function of these muscles is assisting with the raising and rotating of your shoulder blade; they also stabilize this region
• Rhomboids: this is a pair of upper back muscles that run diagonally from the neck and chest vertebrae of the spine down to the back of the shoulder blades; the rhomboids attach the upper limbs to the shoulder blades and help to pull the shoulder blades together during contraction

Approximately 44 million Americans are affected by myofascial pain syndrome, and about 85% of people will experience it at some point in their lives. Middle–aged women who are not physically active appear to have the highest risk for myofascial pain syndrome. Experts are yet to determine why myofascial pain syndrome occurs, but it’s believed that injury or trauma to the spine—from physical activity or repetitive muscle strain—likely plays a role. Other possible causes include consistently using poor posture, which can strain muscles, as well as lack of muscle activity or muscle weakness, stress, working in cold environment, and a pinched nerve.

Although symptoms vary from person to person, myofascial pain is usually described as a deep aching, a throbbing sensation, or tightness and stiffness, which occurs either at the trigger point or in a nearby area (referred pain). Patients will also report the presence of trigger points that cause pain when touched—and sometimes without being touched—tender or sore muscles, and/or weakness. Trigger points and dysfunction of the muscles described above can lead to pain and reduced range of motion neck and shoulders as well.

Red flags

If you notice these symptoms, it’s best to see a physical therapist sooner rather than later, as they can effectively treat myofascial pain with a comprehensive and individualized treatment program. But there are also certain signs that may suggest something else is afoot that may require treatment from another medical professional. These red flags include the following:

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of low back pain under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

In our next post, we’ll describe 4 exercises that will help to reduce your risk for experiencing myofascial pain syndrome.

In our last post, we summarized a meta–analysis that investigated the use of spinal manipulation and found ample evidence from numerous studies that it was effective for chronic low back pain. But spinal manipulation is just one of many interventions that may be used during physical therapy, as all treatment plans are comprehensive and comprised of several techniques and treatments.

Another key feature of physical therapy is that therapists consider it to be of the utmost importance to individualize treatment for all patients. This means that the therapist will carefully consider the patient’s physical capacity, injury history and severity, pain tolerance, goals, and several other factors when designing the treatment plan, and these factors will help determine which interventions are most appropriate and what duration of therapy is needed to increase the likelihood of a positive outcome.

Individualized physical therapy may be particularly effective for low back pain, as research has shown that low back pain is driven by a variety of factors—like sleep, anxiety, and social factors like work engagement—that are not yet completely understood. Therefore, individualized physical therapy can target several of these factors simultaneously to provide maximum benefit, and some studies have found small but promising results in this population; however, the research on this topic is limited, and a powerful study called a Bayesian network analysis was conducted to further explore how physical therapy treatments work for patients with low back pain.

300 patients randomly assigned to one of two groups and followed up for one year

Individuals with a current episode of low back pain for a minimum of 6 weeks and no more than 6 months were recruited to participate and screened, which led to 300 patients being enrolled in the study. These patients were randomly assigned to receive either individualized physical therapy or guideline–based advice, both of which took place over 10 weeks. Participants in the guideline–based advice group underwent two 30–minute sessions over the 10 weeks, which included education about the source of their pain, reassurance about a favorable prognosis, advice to remain active, and instructions regarding appropriate lifting techniques.

Participants in the individualized physical therapy group underwent 10 30–minute sessions over the 10 weeks. Treatment was individualized based on each patient’s specific condition and included a combination of education, self–management strategies, exercises, inflammation–reducing strategies, and manual (hands–on) therapy. All patients were evaluated before the 10–week period, immediately afterwards, and then again at a one–year follow–up for various outcome measures, including low back pain and leg pain intensity, disability, pain persistence, and pain coping. These data were used to conduct the Bayesian network analysis and answer the questions posed about individualized physical therapy.

Results showed that individualized physical therapy directly led to early changes (within 10 weeks) in both disability and pain coping. Individualized physical therapy also indirectly improved back pain intensity, recovery expectations, sleep, fear, anxiety, and depression, and researchers found that these indirect improvements resulted from the early changes in disability. In other words, the gains in physical abilities that patients experienced within the 10 weeks of individualized physical therapy helped to alleviate depression, fear, anxiety and elicit other improvements as well.

This study shows that individualized physical therapy not only helps patients move more easily and with less pain but may address some of the psychological symptoms that many patients with low back pain deal with as well. Since low back pain is a complex condition driven by many varied factors, individualized physical therapy may be a key solution because it accounts for these variables and targets them with unique approaches. Therefore, if you’re dealing with low back pain, we strongly recommend contacting us to schedule an appointment for us to evaluate your problem and get you started on a path to recovery.

As we explained in our first post, physical therapy is strongly recommended as one of the best treatments for most causes of low back pain, and there’s an abundance of research showing that it leads to a variety of improvements. One intervention physical therapists commonly use to treat low back pain is spinal manipulation, a technique in which the therapist applies a controlled thrust with their hands to a joint of the lower spine. Although many studies suggest that spinal manipulation is effective for reducing pain and improving function, international guidelines do not consistently recommend it for low back pain. For this reason, researchers decided to conduct a powerful study called an individual participant data (IPD) meta–analysis to compare the effectiveness of spinal manipulation to other commonly used interventions for low back pain.

A meta–analysis is a comprehensive study that collects and analyses multiple studies on the same topic to determine if an intervention is effective; however, one disadvantage of traditional meta–analyses is that the investigator must rely on how the data are presented in each study, which means poor reporting may often be included in the analysis. An IPD meta–analysis overcomes these issues because the individual data are made available, which leads to more precise data and possibly a more accurate assessment of the treatment’s effectiveness.

For the meta–analysis, researchers performed a search to identify randomized–controlled trials (RCTs)—the gold standard for individual studies—published in 2000 or later on the use of spinal manipulation for low back pain. This search led to 43 RCTs being accepted, about half of which (21) provided data on 4,223 participants. Once these 21 RCTs were established as the sample set for the meta–analysis, researchers documented the specific interventions and their effectiveness on low back pain in each trial. Researchers also assessed the level of bias for each included trial.

Results showed that there was evidence of moderate quality that spinal manipulation reduces pain and improves functional status to a similar degree as other recommended treatments. These improvements were reported at short–term, intermediate–term, and long–term follow–ups. In addition, moderate–quality evidence was identified that spinal manipulation is similarly effective to spinal mobilization, another commonly used manual physical therapy intervention.

Collectively, these findings suggest that spinal manipulation is just as effective as other recommended therapist interventions and may therefore serve a key role in physical therapist treatment plans for patients with chronic low back pain.

If you have low back pain, you’re far from alone. Tens of millions of Americans are affected by it, some of which are only bothered by it occasionally and others who are burdened on a nearly constant basis. Regardless of where you fall along this spectrum, there’s a strong chance you’ve probably searched for remedies to quickly alleviate your pain.

Just as there are lots of people with low back pain, there are also lots of treatment options out there that claim to heal it. Many are probably not worth your time, but one of the easiest and most effective steps you take do for your back is to bolster the strength and increase the flexibility of the structures that could be contributing to pain. This can best be accomplished by staying physically active on a regular basis and by performing specific exercises that target the lower back, abdominal, and core muscles.

To that end, below we share our picks for the 4 best exercises you can do to treat and prevent low back pain.

Our top 4 exercises for low back pain To see videos of each exercise, go to www.MyRTR.net and enter prescription code JS8MY6HX

1. Spine flexion stretch seated
   • Sit in a chair with your feet shoulder–width apart
   • Lean forward while relaxing your arms and keeping your head down toward the floor
   • Hold the position for 30 seconds
   • Repeat for three repetitions total
   • Complete this exercise three times per week
2. Trunk rotation stretch in sidelying
   • Lie on your side with your head supported on a pillow and arms extended in front of you with one hand resting on top of other
   • Bend your hips and knees to 90 degrees
   • Extend your top arm up toward the ceiling, then to floor behind you; follow your hand with your eyes while completing this motion
   • Hold the position for 30 seconds
   • Repeat for three repetitions total
   • Complete this exercise three times per week
3. Extension: prone press–up
   • Lie on your stomach
   • Place both hands flat on the ground, slightly wider than your shoulders
   • Press up, lifting only your upper body only off the ground
   • Return to the starting position
   • Hold the position for 5 seconds
   • Repeat for five repetitions total
   • Complete this exercise three times per week
4. Tensor fasciae latae/iliotibial band (TFL/IT) band stretch against wall
   • Place the foot of your inside leg behind your opposite ankle
   • Shift your weight and hips toward the wall until you feel a stretch
   • Hold the position for 5 seconds
   • Repeat for five repetitions total
   • Complete this exercise three times per week

Regularly performing these exercises will help keep your spine strong and flexible, lowering your chances for low back pain in the process; however, pain may still develop, since there are numerous factors that contribute to the development of low back pain. When this occurs, physical therapy is your best option, and in our next two posts, we summarize some research that shows why.

Low back pain is incredibly common. Nearly one–half of all working Americans notice painful symptoms in the lower back at least once each year, and roughly 31 million individuals are affected by it at any given point in time. Thus, low back pain is essentially just a part of life and something that most of us will eventually encounter, like it or not.

Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something up off the ground or twisting your torso when looking to the side might suddenly give you pause and make you less mobile. Being regularly bothered by pain and movement limitations will often lead one to wonder what’s causing the pain and what steps can be taken next to address it.

The truth is that the specific cause of low back pain is usually difficult to pinpoint, and regardless of its cause, the most effective treatment is almost always a comprehensive and individualized physical therapy treatment program. Nonetheless, although rare, there are a few signs that may be “red flags” and warrant further investigation. To help you better understand what could be causing your back pain and what to do next, below are the 6 most common low back pain conditions seen by physical therapists and some red flags to be aware of:

The 6 most common low back pain conditions treated by physical therapists

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can damaged or tear it; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, strains in the lower back usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Sprains and strains are responsible for most cases of back pain, particularly in younger patients; these injuries can occur either from a single incident or result from repetitive stress over time
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; common symptoms include arm or leg pain, numbness or tingling, and weakness
• Spinal stenosis: a condition in which the spinal canal–the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine–narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is typically only seen in older adults
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of low back pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; osteoarthritis can occur anywhere in the spine, and has been referred to as the most common cause of low back pain in patients over the age of 50; patients typically experience pain and stiffness, while weakness or numbness may also occur for some

Red flags

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of low back pain under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

For more information about red flags to consider with low back pain, click here. In our next post, we describe our picks for the best exercises to reduce your risk for low back pain.

Physical therapy frequently produces notable and lasting improvements that allow patients to lead more mobile lives and participate in activities that they were once unable to complete. As such, it can also help reduce the need for opioids and other pain medications and help patients avoid surgery.

But surgery remains an extremely common intervention that may be necessary for patients that have not tried physical therapy or for those whose condition is too severe. Yet even in these cases, physical therapy can still serve a vital role in helping patients recover as quickly and safely as possible. Physical therapy is typically prescribed to patients immediately after surgery, and the benefits of this approach are exemplified in a recently published study that is described below.

Half of patients complete 7 treatment sessions over 14 weeks

This study was a randomized–controlled trial of patients with femoroacetabular impingement published in July of 2021. Randomized controlled trials involve randomly assigning participants two or more treatment groups, and these types of studies are considered the gold standard for investigating the effectiveness of an intervention.

Patients with symptomatic femoroacetabular impingement for at least three months who were scheduled to undergo hip surgery were recruited to participate and screened for inclusion. This search led to 94 patients fitting the inclusion criteria, who were then randomized to either the experimental group or the control group at a ratio of 1:1.

Patients in the comparison group followed usual care, which consisted of an education program with advice on movements that should be avoided, how to use certain devices and postures, and nonspecific strengthening and stretching exercises for the legs. Patients in the experimental group participated in this education program but also completed a comprehensive exercise program led by a physical therapist. The program was designed to reduce pain and restore range of motion and strength, and consisted of seven 45–minute sessions completed in the 14 weeks following surgery. The featured exercises focused on stabilization, proprioception, flexibility, and strengthening specifically intended for common deficits in femoroacetabular impingement.

In the final assessment taken 14 weeks after surgery, patients in the experimental group reported significantly greater improvements than the comparison group in all movements evaluated, including hip flexion, extension, and range of motion. Patients in the experimental group also reported significantly greater pain reductions, as well as significantly better scores on a test of hip function than the comparison group at 14 weeks after surgery. Hip function was rated as “excellent” in the experimental group and “good” in the comparison group.

These findings show that a comprehensive physical therapy program can lead to less pain, greater hip mobility, and a faster restoration of functional abilities in patients with femoroacetabular impingement who undergo surgery. This study also highlights why physical therapy is regarded as a necessity for all patients who go on to have surgery for hip pain or any other musculoskeletal condition. Therefore, if your hip is bothering you and you’re scheduled for surgery or considering this route, we can’t recommend physical therapy strongly enough if you’d like to bounce back from the procedure as quickly and safely as possible.