As we discussed in our first post this month, most people are aware that exercise is good for you and is recommended for achieving and maintaining optimal health. Yet still, a significant portion of the population doesn’t do it. We mentioned in that post that lack of time and motivation—or both—are two common explanations given for why people don’t exercise, but these certainly aren’t the only reasons.

Many other individuals, particularly middle– and older–aged adults, very much want to exercise, but may be unable to do so on account of physical limitations. Poorer balance, reduced flexibility, and weakened muscles all tend to become more likely through the aging process, but perhaps the most common ailment in older populations is joint pain. Issues like osteoarthritis, bad backs, sore shoulders, and knee and hip pain all increase in frequency the older we get, often making simple functioning throughout the day more difficult. Together, each of these issues can serve as a major barrier that prevents adults with physical limitations from exercising.

What you need to understand is that nearly every one of these barriers can be overcome, and one of the best ways to get there is by seeing a physical therapist.

Finding exercises that are perfectly suited for you

If you happen to be dealing with joint pain of any sort, you may think it’s best to avoid any activities that strain the injured area so that you don’t aggravate it any further. For a long while, this was believed to be the best approach for joint issues, but the prevailing logic has since changed, dramatically. Research over the past 30+ years has shown that physical inactivity is one of the worst things you can do for joint pain, as it leads to weaker muscles, less flexibility, and poor heart and lung health. In effect, too much rest will prolong one’s recovery or even make the condition worse over time.

Instead, current recommendations strongly promote frequent exercise for those with joint issues because it increases flexibility, bolsters strength, and promotes healing by increasing the flow of blood to the injured area. Strong and healthy muscles can more effectively protect bones and joints, which is one reason regular exercise significantly lowers the risk for future musculoskeletal injuries. And over time, higher physical activity levels will increase stability and reduce the risk and number of falls in older adults as well.

But knowing this, getting from point A (physical inactivity) to point B (regular physical activity) often requires some guidance for many adults, and this is where physical therapy come in. Physical therapists are movement experts that are trained to assess any limitations or impairments that may be affecting one’s mobility, and then address these issues with a personally tailored treatment program. If a patient comes in who wants to exercise more but doesn’t think they can do so because of joint pain, poor balance, weakness, or any other potential barrier, a physical therapist will work with this individual to find forms of exercise that are feasible for their specific physical abilities. From there, the physical therapist will continue to monitor your progress and then introduce ways to help you gradually advance to more intense forms of exercise once you’re ready. Each exercise program can be modified regularly based on your response, so you’re never falling out of your comfort zone.

Ultimately, it doesn’t matter how old you are, if you’re out of shape, or if you have any other physical impairments. Your physical therapist will find a way to help you become more physically active in a manner that’s safe, comfortable, and effective for your unique goals.

If you’re interested in learning more about how physical therapy can help you safely increase your activity levels and introduce exercise to your life, contact us today.

Dieting can be overwhelming. With new research constantly emerging, new diets seemingly popping up every week, and experts regularly claiming to have discovered the magic bullet to weight loss or nutrition, it’s difficult to even keep track of what’s out there these days, let alone determine which type of diet is best for you.

Physician Peter Attia has recognized this problem and attempted to simplify the process of understanding how diets work by using a basic nutritional framework that consists of three parameters:

• Dietary restriction: what you eat or don’t eat; in other words, if you’re focusing on only eating certain types of foods while avoiding other types, the diet would fall into this category
• Caloric restriction: how much you eat; this means counting the number of calories you consume and aiming for a specific target range
• Time restriction: when you eat or don’t eat; intermittent fasting, in which you only eat during a predetermined period each day and fast for the remainder, is the best example of a time–restrictive diet; we’ll explain this in more detail later

In Dr. Attia’s framework, each of these restrictions represents a lever that be plotted on an x–y–z axis. If you eat whatever you want, whenever you want, and as much as you want, you’re not pulling any of these levers. Instead, you’re following what’s called the standard American diet, which consists of lots of sugar, refined carbohydrates, saturated and trans fats, and is associated with high rates of obesity, diabetes, and other health issues. To break out of the standard American diet, Attia recommends pulling at least one of these levers. Pulling two, or possibly three, is even better.

Just about every diet that has ever been developed is structured on pulling one or more levers by regulating what, how much, and/or when you eat. All diets claim to help individuals lose weight or improve other aspects of their health by adhering to these restrictions, and many do have the potential to be beneficial—so long as it’s followed on a long—term basis.

Now that you have a general understanding of this framework, we’d like to describe a few of the most popular diets out there currently and explore what restrictions they recommend and the health benefits associated with each one.

Vegan/vegetarian

Vegan and vegetarian diets are similar, but there is one key difference between them. A vegan diet consists only of plant–based foods and no foods derived from animals whatsoever. A vegetarian diet, on the other hand, does not include any meat, but may include other animal products like eggs (ovo vegetarian) or dairy (lacto vegetarian). Pesco vegetarians eat seafood, which doesn’t technically fit the definition of vegetarian, but oftentimes they are still classified together.

As you can see, vegan and vegetarian diets clearly pull on the dietary restriction lever of Attia’s nutrition framework. They do this by avoiding consumption of meat and possibly other animal–based products (depending on the specific type of diet). Vegans and vegetarians may also do indirectly do some caloric restriction by eating less high–calorie foods, but this depends largely on their food choices within each diet. Health benefits that have been identified with these diets include the following:

• A vegan diet can lower high cholesterol levels, mainly by eliminating lots of saturated fats and completely eliminating dietary cholesterol that’s only found in animal products
• Vegan diets are also associated with has anti–inflammatory effects in patients with heart disease and have been found to improve lipid and glycemic control in type 2 diabetics, which are two important parameters for these patients
• A vegetarian diet reduces the risk for heart disease and death related to heart issues
• Caution: a vegan or vegetarian diet isn’t automatically healthy, since potato chips, soda, and vegan ice cream all technically fit this classification

Ketogenic diet

The ketogenic diet—or keto for short—places a strong emphasis on rich sources of fat (like meat and dairy), while limiting the consumption of foods high in carbohydrates (like fruit, whole grains, beans, and some vegetables). Moderate servings of protein are also allowed, but fats account for most of the calories consumed.

As with the vegan and vegetarian diets, the keto diet also pulls the dietary restriction lever by limiting the amount of carbs and protein while focusing on lots of fats. If the ketogenic diet is being followed for the primary purpose of losing weight, it can also pull the caloric restriction lever, but this is not always the case. Some of the health benefits associated with this diet include the following:

• Reduces blood pressure
• Helps with weight loss
• Improves lipid levels and has a positive impact on other markers that are associated with heart disease
• Caution: people on the keto diet are more prone to gain back weight than others because it can be difficult to stick to in the long term

Intermittent fasting

One of the most rapidly emerging dietary trends is intermittent fasting, which involves only consuming meals within a strictly defined period. The most popular variations are the 16/8, 18/6, and 20/4 time–restricted feedings. This means an individual will fast for 16 hours and then eat only within an 8–hour “nutritional window” (or 18 hours of fasting followed by 6 hours of eating, etc.). A more aggressive approach includes alternating a 24–hour fasting period with a 24–hour eating period, two or three times a week. During eating periods, individuals do not have to be selective about what they eat, but healthy foods will lead to better results.

Intermittent fasting is clearly different from the other diets in that it focuses almost exclusively on pulling the time restriction lever. Some individuals who follow intermittent fasting will combine it with some other diet to also the types of foods they consume, but this is not a requirement. Intermittent fasting has been associated with several health benefits, including the following:

• Reduces blood pressure and prevents hypertension
• Can lead to weight loss
• Improves glucose metabolism and increases sensitivity to insulin in diabetic patients
• Caution: intermittent fasting can be difficult to sustain long–term, and it may also lead to negative side effects like mood swings, chronic tiredness, headaches, dizziness, and nausea; it’s also not recommended for those with hormonal imbalances and pregnant and breastfeeding women

Each diet clearly has some attractive qualities and could be good for your overall health if done properly. So ultimately, if you’re thinking about trying a new diet, the main question you should be asking yourself is this: which one can I stick with in the long term. Most diets fail because dieters are only able to maintain the restrictions for a few weeks or months. But enacting real change requires adopting a diet that you can maintain for the long haul, at which point it transitions from a “diet” to just the way that you eat.

Disclaimer: Physical therapists are not licensed to provide nutrition recommendations. This post is intended for informational purposes only.

In our last post, we explored a few of the many health benefits associated with regular physical activity and discussed two popular approaches to exercise that are worth considering: high–intensity interval training (HIIT) and moderate–intensity continuous training (MICT). Since HIIT has now become something of a buzzword and MICT is essentially the type of exercise most people do—often without knowing its technical name—it’s likely that there are some unanswered questions out there regarding how to go about these types of training and what’s right for you. In response, in this post we’ll answer some of the most frequently asked questions about HIIT and MICT.

Q: What is aerobic exercise?

A: Also known as endurance or cardiovascular exercise, aerobic exercise is any form of physical activity in which oxygen is heavily involved. This is most clearly evident by noticing an increase in your heart rate and by breathing more deeply during these activities, which are signs that your body is maximizing the amount of oxygen in the blood to help you use it more efficiently. HIIT and MICT are both considered forms of aerobic exercise, while other examples include walking, jogging, swimming, biking, jumping rope, and playing basketball. Over time, performing aerobic exercises can significantly improve the function and performance of the heart, lungs, and circulatory system, leading to various benefits, such as better heart health, sleep patterns, weight regulation, and metabolism.

Q: How do I calculate my resting and optimal exercise heart rate?

A: Since all types of aerobic exercise increase the heart rate, it’s important to understand how far you should be pushing yourself to make sure getting the most out of your workouts but staying safe while doing so. Your resting heart rate is the number of times your heart beats per minute (bpm) when you’re at rest, and it’s an indicator of your physical fitness level. Many fitness trackers and smartwatches measure track your heart rate automatically, but if you don’t have one of these devices, you can measure your resting heart rate manually by taking your pulse at your wrist or (below the base of your thumb) over 60 seconds (or for 6 seconds and multiplying by 10, 15 seconds and multiplying by 4, etc.). An average adult heart rate is 60–100 beats bpm, with the lower end indicating good overall fitness and the higher end generally associated with health problems like metabolic syndrome.

The next step is to calculate your maximum heart rate, which can be done by using one of several formulas, the easiest of which is subtracting your age from 220. Once you know your maximum heart rate, you can choose from aerobic activities that range from very light (under 57% of maximum heart rate) to maximal (96–100% of maximum heart rate). If you’re new to exercise, it’s best to start in the low range and gradually work your way up until you find your target, or optimal heart rate zone.

Q: What are some examples of HIIT programs?

A: If you’re just getting started with HIIT, here are a few examples of single–exercise workouts that are great for introducing you to this type of training:

• Bike: pedal on a bike as hard and fast as possible for 30 seconds, then pedal at a slow, easy pace for 2–4 minutes; repeat this pattern for 15–30 minutes
• Jog/run: after jogging to warm up, sprint as fast as you can for 15 seconds, then walk or jog at a slow pace for 1–2minutes; repeat this pattern for 10–20 minutes
• Squats: Perform squat jumps as quickly as possible for 30–90 seconds, then stand or walk for 30–90 seconds; repeat this pattern for 10–20 minutes

You can also find a multitude of free HIIT programs on YouTube and other fitness websites. One great website for free videos is Fitness Blender.

Q: What are some examples of MICT programs?

A: Remember that MICT is performed at a moderate intensity but for longer periods of time than HIIT (MICT exercises are typically completed at 55–75% of one’s maximum heart rate, while HIIT hits at around 80–85% of maximum heart rate). Following our last examples, you can modify a biking or jogging HIIT workout and make it an MICT workout instead by reducing the intensity, eliminating the rest periods, and extending the duration. In other words, a bike ride at a moderate pace for 20–40 minutes or a jog at a moderate pace for 20–30 minutes.

Other examples of MICT activities include any of the following, performed at a moderate pace for at least 20 minutes:

• Swimming
• Brisk walking
• Playing a pick–up game or practicing basketball, soccer, or football
• Hiking
• Kayaking

Q: Is HIIT safe for older adults?

A: In most cases, yes, but this depends heavily on your current fitness level. One of the most attractive features of HIIT workouts is that there are practically endless modifications that can be made to the types of exercises, durations, and rest periods to suit your activity level. If you’re interested in HIIT but aren’t already physically active, we strongly recommend consulting a doctor or a physical therapist, who can give you a fitness test and provide you with guidance to get you started.

Q: How can I start a HIIT or MICT program?

A: As we mentioned above, physically active individuals can get started on their own, but if you’re new to moderate– or vigorous–intensity exercise, talk with your doctor or physical therapist first to clear you for activity and help move on the right track.

In our next blog, we’ll look at the role that various diets can also play in reducing the risk for various health conditions.

If there’s anything the public knows about exercise, it’s simple: doing it is good for you. This association is undoubtedly common knowledge by this point, but what many people may not fully understand is just how far these benefits go. Research continues to pour in year after year showing that maintaining adequate physical activity levels is associated with a plethora of both physical and mental health benefits, and it can extend your expected lifespan as well.

This list is expansive and encompasses numerous fundamental areas of health, but some of the most notable physical benefits include the following:

• Leisure time physical activity reduces the risk for several types of cancer, including liver, lung, breast, kidney, colon, rectal, and bladder cancer
• Regular physical activity and high fitness levels are associated with a reduced risk for premature death from any cause, particularly from heart disease in individuals with no symptoms
• Regular exercise increases strength and flexibility and lowers the risk for musculoskeletal conditions like osteoarthritis, strains and sprains, fractures, and other painful problems; it also increases stability and reduces the risk for falls in older adults
• Regular physical activity reduces the risk for developing type 2 diabetes—especially in individuals who are considered “prediabetic”—and improves outcomes in individuals who already have diabetes

HIIT: an important acronym for time–crunchers

Unfortunately, the problem for most individuals isn’t having doubts that exercise can improve their health. Many people simply struggle to find the motivation and/or the time to become physically active as regularly as they want to be or think they should be. One possible solution for those with busy schedules is to train more aggressively, but in shorter periods of time, which is the basis of high–intensity interval training (HIIT).

HIIT has been around for quite a while, but has been growing rapidly in popularity over the last few years. HIIT is essentially a training technique in which you give an all–out, 100% effort through quick intense bursts of exercise, which are then followed by shorter recovery periods. Since your body is working so hard during a HIIT workout, it increases your heart rate and helps you burn more fat in less time. HIIT workouts also increase the body’s need for oxygen during these extreme efforts, which, over time, will help increase your cardiovascular ability and strengthen your heart. In addition, HIIT can significantly bolster endurance, leads to fat instead of muscle loss, is quick and convenient—workouts can be completed just about anywhere in as little as 10 minutes— and usually does not require any equipment.

MCIT: a less intense alternative

Moderate–intensity continuous training (MCIT)—sometimes referred to as steady–state exercise—involves a sustained physical effort, but with no periods of rest in between. Compared to HIIT, MICT workouts are much less intense, with exercise performed at a moderate intensity over longer periods of time. This typically corresponds to 55–75% of one’s maximum heart rate, whereas HIIT typically involves about 80–85%. Similarly, MICT is performed at 40–65% of maximal oxygen consumption, while HIIT usually pushes individuals to 75–80% of this limit. MICT probably encompasses most types of exercise, and a good example is continuously cycling on a stationary bike at a constant pace for 20–40 minutes.

Both MICT and HIIT have their merits and are attractive for different reasons. Someone who’s short on time and in good shape may be interested in getting “more bang for their buck” with HIIT, while others who are not comfortable exercising at such a high intensity may prefer the more reasonable pacing of MICT. Research has also shown that both approaches to exercise are associated with similar health benefits. According to one study (the Generation 100 study) that evaluated more than 1,500 adults between the ages of 70-77 who regularly engaged in HIIT or MICT for five years, those who completed HIIT experienced greater health benefits and a reduced risk of dying compared to the MICT group. But another powerful study called a meta-analysis found that there was no difference between HIIT and MICT when it came to improving body composition and body fat percentage.

The long and short is this: HIIT and MICT are both great options for becoming and staying active that can lead to a variety of healthy benefits. What it really comes down to is how much free time you have in your schedule and your comfort level with intense exercise, but either way, it’s a win–win.

Read our next post for answers to some of the most common questions about HIIT and MICT.

In our last three post, we’ve looked into the most common causes of low back pain and offered some tips on what to do if and when it strikes. Taking these steps and making other smart lifestyle changes–like moving more, sitting less, and improving your posture and sleeping habits–undoubtedly has the potential to significantly reduce low back pain levels. But even after making all the right changes, back pain will continue to be a problem for many patients.

For these individuals, a much more systematic and comprehensive treatment approach is needed that addresses the impairments present, and there is no other option that fits this bill quite like physical therapy. Physical therapy is predicated on first identifying any limitations or dysfunctions that can be contributing to a patient’s pain, and then developing a customized treatment plan to targets these faults with a series of movement–based interventions. While individual goals may vary from patient to patient, the overall goals of physical therapy are always to reduce pain levels, increase physical function, and prevent further recurrence of pain.

Physical therapy is associated with a host of benefits that will save patients time and money while putting them on a path to positive long–term outcomes, and the earlier a patient sees a therapist, the greater the benefits will be. To give you a clearer idea of what physical therapy can do for your low back pain, here are four of its most notable evidence–based advantages over other approaches to treatment:

The top 4 benefits of early physical therapy for low back pain

1. Reduces the need for additional care
• Many patients with low back pain see their primary care physician as their first point of contact with the healthcare system because it’s usually the easiest approach, but doing so can actually lead to delays in receiving appropriate treatments
• By seeing a physical therapist first, on the other hand, patients can start their treatment program right away, which will usually include various strengthening and stretching exercises, manual (hands–on) therapy techniques, and other pain–relieving interventions; according to one study, early physical therapy reduces the need for additional treatments in the future, and the earliest initiation of therapy was found to be associated with the lowest need other interventions
2. Leads to similar outcomes compared to surgery and helps patients avoid it
• Due to the high costs, various risks, and extensive recovery period, surgery should only be considered as a last resort for most cases of low back pain, after all other options have been exhausted; still, some patients will choose to undergo surgery much earlier, either because they have abnormal MRI findings, want a “quick fix,” or for other reasons
• But research has shown that physical therapy can lead to outcomes that are just as good as surgery; in one study of patients with spinal stenosis who were candidates for surgery, no differences in painful symptoms or physical function were identified in patients who underwent surgery compared to those who followed a course of physical therapy
• Research has also shown that early physical therapy can help patients avoid surgery
3. Helps patients avoid opioids
• Opioids are powerful pain–relieving medications that should prescribed with extreme caution in only rare cases of low back pain–if at all–due to the high associated risks for abuse, dependence, and overuse
• By seeing a physical therapist early, patients can significantly reduce the likelihood of being prescribed opioids in the future; according to one study, patients who consulted with a physical therapist earlier in the course of their care had lower rates of opioid prescriptions compared to those who saw a physical therapist late or never
4. Results in lower overall costs
• For patients with low back pain, getting treatment right away, undergoing fewer additional tests and treatments, and avoiding surgery and opioids also equates to lower overall healthcare costs
• Many studies have shown the cost savings associated with early physical therapy are substantial, with one study finding that costs for those who started physical therapy within three days of being diagnosed with low back pain were just under $3,000 over one year, while for those who waited 29–90 days to do so, costs were more than double, at nearly $6,400

With such a clear set of benefits, it’s easy to see why physical therapy is regarded as the safest and most logical choice for low back pain. So if you’re dealing with any persistent or chronic pain, we strongly recommend making an appointment with your local physical therapist to get started on a path to less pain, better function, and greater enjoyment of the things you love.

Low back pain is more complex than it might appear on the surface. Many conditions can be responsible–as we discussed in our first post–and there are also numerous potential factors that could play a role in the development of pain, some of which are known and others that are still being investigated. But one variable that is known to definitively contribute to low back pain is inflammation.

Inflammation is a sign that the immune system is working effectively and protecting the body from potential threats. But too much inflammation could be a sign of other issues at work, and it can lead to a variety of damaging effects when it continues unabated, one of which is pain. For this reason, taking certain supplements and eating foods that are known to fight inflammation is not only a great approach for overall health, but it may also be an effective weapon for alleviating your low back pain.

With this in mind, here are some anti–inflammatory nutritional supplements and food items/groups that you may want to consider adding to your diet.

Anti–inflammatory nutritional supplements

• Omega–3 fatty acids: these chemicals, which are found in fatty fish and an abundance of other foods, are regarded as one of the best fighters of excessive inflammation in nature; for those who don’t like to eat fish, fish oil or omega–3 fatty acid supplements can be taken instead, and research has shown that these supplements are effective for reducing disc degeneration
• Devil’s claw: devil’s claw is an herb derived from native African plant called Harpagophytum procumbens; the active ingredient in devil’s claw, harpagoside, decreases swelling and inflammation, and one comprehensive study called a Cochrane Review found that taking it on a daily basis can reduce back pain and the use of pain medications
• Bromelain: bromelain is an enzyme found in pineapples that has been used for its medicinal purposes for centuries; studies have shown that strong anti–inflammatory properties, which could translate to less back pain
• Capsaicin and comfrey: capsaicin is the chemical responsible for the sensation of heat in hot peppers, while comfrey is an herb derived from a flower; both are available as topical creams and are believed to alleviate pain through mechanisms other than fighting inflammation; research has shown that both comfrey and capsaicin may be effective for tackling back pain

A plant-based diet is best for lowering inflammation and reducing back pain

Nutritional supplements may be a helpful tool to fight inflammation and reduce your low back pain, but they are called supplements for a reason. To effectively manage your inflammation levels, you need to also adhere to a diet that’s loaded with anti–inflammatory foods while avoiding foods that increase inflammation as much as possible. One of the easiest ways to accomplish this is by following a diet that is based primarily on plants, as fruits and vegetables–especially those that are dark in colors like green, red, orange, and blue–is extremely effective for reducing inflammation.

Several studies have also found that clogged arteries supplying blood to the spine could be another important factor that likely contributes to several low back pain conditions. Since clogged arteries and some other blood conditions are known to be related to one’s diet, it’s been suggested that following a plant-based diet can help address these issues and alleviate some causes of low back pain in the process. Thus, a plant-based diet could be doubly effective for treating low back pain.

Plant–based diets can be easily customized depending on your tastes and preferences, but here are a few suggestions to consider:

• Aim to eat lots of dark green vegetables, which are all great at fighting inflammation, especially kale, spinach, and broccoli
• When selecting other fruits and vegetables, always remember that darker usually means more anti–inflammatory properties; some great options include carrots, beets, sweet potatoes, cherries, berries, and pomegranates
• Add lots of herbs and spices to your food, particularly basil, cinnamon, ginger garlic, oregano, and onions, all of which are anti–inflammatory
• Cook with olive oil and or add it to your foods
• Try drinking herbal and green, white, and oolong teas
• Try to avoid processed foods, fast foods, foods high in saturated fats, which increase inflammation (eg, white bread, pasta, and rice, and sugary drinks and snacks)

Diet is a major component of good overall health, and taking control of it could make a difference in your back pain, yet some pain will persist even when following an optimal diet. Read our last post of the month for a look into what physical therapy can do for low back pain that fails to improve.

Disclaimer: Physical therapists are not licensed to provide nutrition recommendations, and this post is intended for informational purposes only.

If you have low back pain, you’re far from alone. Tens of millions of Americans are affected by it, with some only being bothered occasionally and others 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 tons of people with low back pain, there are also tons of treatment options out there that claim to be a solution. Many are probably not worth your time, but one of the easiest and most effective things you can 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.

How to perform the basic bridge exercise

One exercises we strongly recommend for your low back pain is called the basic bridge, which is also known as the glute bridge or hip raise. The basic bridge exercise primarily stretches and strengthens the gluteus muscles of the buttocks and hamstring muscles in the back of the thigh. And when done correctly, it also targets various muscles that support the abdominal, lower back, and hip regions. As a result, regularly performing this exercise will lead to greater strength in these muscle groups, which will improve your posture and can help alleviate lower back pain. Even if you’re dealing with chronic low back pain, properly executing the basic bridge can lead to reductions in pain.

Here’s how to do the basic bridge exercise (click here for a video demonstration):

1. Lie on your back with your hands at your sides, knees bent, and feet flat on the floor under your knees
2. Tighten your abdominal and buttock muscles by pushing your low back into the ground before you push up
3. Raise your hips to create a straight line from your knees to shoulders
4. Squeeze your core and pull your belly button back toward your spine
5. Hold for 20–30 seconds, and then return to your starting position
6. Complete at least 10 repetitions

• Cautions: Two of the most common mistakes that people make when performing the basic bridge are raising the hips too high, which can strain the lower back, and allowing the hips to drop while trying to hold the position. Try to avoid this mistakes and keep good form throughout, as it’s better to hold the correct position for a shorter time rather than an incorrect position for a longer duration.
• Modifications: If the basic bridge starts to feel too easy after doing it regularly over time, you can increase the difficulty by adding an exercise band, dumbbell, or exercise ball. From there, you can even try to single-leg bridge, which is a variation on the basic bridge in which you keep the same form, then raise one of your legs off the ground about 10 times, and then repeat with the opposite leg.

While the basic bridge is a great starting point, it may not completely eradicate your low back pain on its own. For persistent or chronic pain, a comprehensive treatment program prescribed by a physical therapist may be needed, and we’ll take a closer look at the benefits of physical therapy in our last post this month.

Few conditions can compete with back pain when it comes to prevalence. As one of the most common reasons for visiting a doctor, about 25% of Americans have dealt with low back pain in just the past three months, and up to 80% of the population will encounter it at least once in their lives. This unfortunately means that if you’ve never had a bout of back pain, there’s a strong chance that you will at some point in the future.

But you don’t need to worry. If you’re dealing with back pain now or it strikes down the road, you can take solace in knowing that most cases will eventually improve without the need for any drastic measures. Read on for a closer look at low back pain through a series of frequently asked questions about what usually causes back pain, why the cause is not usually very important, and what you should do if you’re affected by it.

Q: What conditions can cause my lower back pain?

A: The list of conditions that can lead to low back pain is extensive, but some of the most common causes include sprains and strains, spinal stenosis, a herniated disc, joint issues, and degenerative disc disease. To understand how these conditions affect the spine and surrounding structures, we first need to give a quick anatomy lesson.

The spine consists of 33 bones called vertebrae, which are stacked on top of one another and interlocked to form the spinal column. The vertebrae are connected by small joints that allow the spine to move in various directions, and in between each vertebra is a structure called an intervertebral disc. These discs consist of a tough exterior and are filled with a jelly-like substance, and their purpose it to absorb shock and prevent the vertebrae bones from rubbing against each another.

• Sprains and strains: sprains involve ligaments and strains involve muscles; both are injuries that result from these structures being pushed beyond their limits, either from a single incident or due to repeated stress over time
• Spinal stenosis: a condition in which the spinal canal narrows, which puts pressure on the spinal cord; it usually occurs later in life
• Joint dysfunction: a term used to describe when any of the joints of the spine—including the facet joints or sacroiliac joint—are not working properly
• Herniated disc: a condition in which the softer jelly-like substance of the intervertebral disc 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
• Degenerative disc disease: an age-related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to disc herniation and other problems

Q: Is it essential to identify what’s causing my lower back pain?

A: In most cases, no. While it’s good general knowledge to be aware of these common causes of low back pain, the truth is that getting an accurate diagnosis is usually less important than you might think, especially when the pain is not chronic. For starters, because the anatomy and mechanics of the spine are so complex, only about 20% of patients of back pain actually end up receiving a specific diagnosis. In addition, most cases of low back pain are managed with a fairly similar set of treatments, regardless of what condition is believed to be responsible. This is because low back pain is typically approached based on the symptoms present rather than the exact malfunction of the spine.

But there are certain situations when obtaining an accurate diagnosis may be necessary. The biggest concern is that a more dangerous condition or disease is causing low back pain, and if so, it may require immediate treatment. These are generally the same indications that warrant a diagnostic test like an MRI for low back pain (discussed next) and include severe neurological symptoms and other red flags that could suggest an infection, spinal fracture, cancer, or a condition called cauda equina syndrome. These problems only account for a very small percentage of low back pain cases and are unlikely to be responsible, but your healthcare provider will remain aware of the risk for them nonetheless.

Q: Do I need to get an MRI right away?

A: Probably not. As we described above, MRIs are only recommended in rare cases when there is suspicion of a potentially dangerous diagnosis. In the absence of any of these red flags, an MRI will not do much good, and can actually lead to unnecessary treatments that may not address the pain. The reason is that “abnormal” findings from MRIs and CT are extremely common, as one study found that 80% of 50-year-olds and 96% of 80-years-olds with no back pain symptoms had signs of disc degeneration on their imaging tests. This shows that the imaging test usually does not reveal the source of the pain, which means that repairing a herniated disc may not truly fix the problem.

Q: What if I have a herniated disc?

A: Understand that many other people have the same condition, and as we’ve just explained, and it may not be responsible for pain. And if you do have low back pain and a herniated disc, that still doesn’t guarantee that it’s the cause of your symptoms. Plus, most herniated discs eventually regress—or heal—on their own when surgery is not performed. This is why the best thing to do is to address the pain through treatments like physical therapy while avoiding surgery.

Q: What should I do after I experience low back pain?

A: First off, don’t panic! The prognosis for low back pain is good, and most cases will eventually get better regardless of what’s done to address it. But there are certain steps you can take to increase the chances of making your pain subside, such as:

• Stay physically active and avoid too much bed rest
• Try returning to normal activities as soon as possible
• For persisting pain, try nonsteroidal anti-inflammatory drugs
• Avoid opioids under most circumstances, as these drugs are frequently associated with misuse, abuse, and dependence
• Consider seeing a physical therapist to get started on treatment early, which we’ll discuss in more depth later

Q: Should I see a physical therapist?

A: Absolutely! We can’t be any clearer about this one. Physical therapy addresses the symptoms of low back pain right away and is one of the safest and most effective options to reduce pain and help patients regain their function. Read our last post of this series for a closer look into physical therapy.

Inflammation is one of the body’s greatest weapons. When a foreign substance enters your body—through an infection, injury, or some other cause—the immune system kicks into action and sends out inflammatory cells that are capable of containing the threat and protecting the body from any further damage. Any time you’ve experienced the typical symptoms of a cold or noticed redness and pain after getting a paper cut, these signs of inflammation are completely normal and natural, and show that the immune system is doing its job by fixing the problem and keeping you safe.

But that’s not to say all inflammation is good. Inflammation is only meant to occur when a real threat is detected, and then it should stop after the threat has been resolved. Too much inflammation, on the other hand, puts your body in a constant state of high alert, which is dangerous. Many health conditions are associated with chronic inflammation, including heart disease, diabetes, Alzheimer’s disease, autoimmune conditions, arthritis, obesity, and several types of cancer. As such, keeping your inflammation levels in check is often considered a chief component of healthy lifestyle.

The encouraging news is that you have the power to partially control your inflammation levels. Smoking, excessive alcohol intake, and being overweight or obese can all lead to increased inflammation and should therefore be avoided, but your diet plays a major part in the inflammatory process as well. A rapidly growing body of evidence has shown that there are many foods that have anti-inflammatory effects and that following a diet rich in these foods can reduce the risk for a range of health conditions and death. Among the many reported benefits of an anti-inflammatory diet are the following:

• Less joint damage, delayed disease progression, and possibly less reliance on medication in patients with rheumatoid arthritis
• A lower risk of dying in smokers from any cause, particularly heart disease
• Faster recovery after athletic training
• Better management of pain associated with aging
• Heart protection
• Improved quality of life for patients with multiple sclerosis

Four foods that help fight inflammation

Perhaps the best part about an anti-inflammatory diet is that it’s involves a great deal of common sense and overlaps with many other common dietary recommendations. Foods that generally increase inflammation levels also happen to be foods that are generally regarded as “unhealthy.” These include:

• Refined carbohydrates like white bread, pastries, and sweets
• Red meat and processed meat like hot dogs and sausages
• Fried foods
• Foods and beverages with high sugar content
• High-fat dairy products
• Foods with high saturated fat content

It may not surprise you to hear, then, that many of the foods that are found to have anti-inflammatory effects are also foods that are generally perceived regarded as “healthy.” Unprocessed, natural, fresh foods like fruits, vegetables, and legumes, as well as whole grains, healthy fats, and herbs and spices, are all considered anti-inflammatory, which highlights the diverse array of options that fall under this umbrella. To better guide you, here are four foods and food items that you may want to consider introducing to your diet based on their anti-inflammatory properties:

Turmeric: research has shown that turmeric contains many compounds that exhibit both anti-inflammatory and anti-cancer activities, including curcumin, which is the chemical that gives this spice its bright yellow color; in addition to alleviating inflammatory conditions, turmeric has also been found to reduce the activity of Alzheimer’s disease in patients who have this condition. Mushrooms: many mushrooms contain compounds with a host of beneficial properties, including the capacity to reduce inflammation; mushrooms are also low in calories and fat but high in polyunsaturated fats, which adds to their beneficial health profile. Fatty fish (salmon, tuna, mackerel, and sardines): these fish are all extremely high in omega-3 fatty acids, which are capable of slowing down or stopping many aspects of inflammation; fish oil supplements are also loaded with omega-3s and can be taken daily. Flaxseed: flaxseed is another rich source of omega-3 fatty acid, and adding this to one’s diet has been associated with a host of health benefits, including a reduced risk for cardiovascular disease and cancer, as well as improvements to gastrointestinal health and diabetes.

Disclaimer: physical therapists are not licensed to provide nutrition recommendations, and this post is intended for informational purposes only.

In our first post, we discussed three of the most common conditions that occur in the lower leg and answered some frequently asked questions about these issues. Next, we walked you through three key exercises that you can perform on your own to alleviate pain related to several common lower leg conditions. As we pointed out, regularly performing stretching and strengthening exercises can lead to notable gains for many patients, but there are limits to these benefits.

For pain and functional limitations related to shin splints, Achilles tendinitis, or plantar fasciitis that persists after you’ve tried to correct it independently, additional care from a trained professional is needed. The clearest answer to this call is physical therapy. Physical therapists are movement experts who help patients overcome their impairments with a multifaceted treatment approach, and they are your best option available for each of these common lower extremity conditions.

Research has shown that many of the interventions frequently utilized by physical therapists are effective for addressing these disorders and are featured in the relevant treatment guidelines as a result. For example, the clinical practice guidelines for plantar fasciitis assign an “A” grade to stretching, manual therapy, taping, and foot orthoses, which are some of the most commonly used physical therapy interventions for this condition. An “A” grade means that there is “strong evidence” to support the recommendation for these therapies. Another study found that patients with plantar fasciitis who received manual—hands-on—therapy from a physical therapist averaged fewer visits and lower costs than those who did not.

Similarly, the clinical practice guidelines for Achilles tendinopathy—an umbrella term that includes Achilles tendinitis and tendinosis—assign an “A” grade to exercise, a “B” grade to activity modification, and a “C” grade to stretching exercises. Other research has also found exercise to be the primary treatment strategy for Achilles tendinopathy, particularly eccentric exercise, which is the gold standard for this condition (and will be discussed later).

An overview of physical therapy for shin splints, Achilles tendinitis, and plantar fasciitis

While there are certain interventions consistently used for these conditions, each physical therapy treatment program will be unique based not only on the specific disorder, but the patient’s needs, abilities, and goals as well. Below is a brief summary of the treatments most commonly utilized to address each of these conditions:

Shin splints

• Strengthening exercises: one way to decrease stress on the lower leg is by increasing the strength of the muscles associated with the hip; therefore, hip rotation, hip abduction, and hip extension strengthening exercises are frequently prescribed
• Strengthening exercises can also be performed to increase your arch and shin muscle strength to decrease the overpronation (flattening out) of the arch of the foot
• Stretching exercises: these typically target the calf and foot muscle
• Balance exercises: the single-leg stance progression exercise, as well as squats and heel raises can all help to improve balance
• Footwear education: your therapist may provide suggestions for your footwear to ensure that your feet are fully supported when walking and exercising
• Shoe orthotics or inserts: your therapist may prescribe these if your feet flatten out too much or if your foot muscles are weak to better support the arch of your foot

Achilles tendinitis

• Eccentric calf-strengthening exercises: these exercises lengthen a muscle at the same time it’s being contracted and are strongly recommended for Achilles tendinitis; the best example is the heel drop
• Heel drop: stand on the edge of a stair or stable platform—with one or both feet—and hold on to a rail to keep your balance; lift your heels off the ground, then slowly lower them to the lowest point possible in a controlled fashion; repeat this step 20 times; weights can be added
• Manual therapy: these hands-on techniques administered by a physical therapist include massage, manipulation, and mobilization, which improve mobility and function, and alleviate symptoms
• Stretching exercises: the physical therapist will usually guide you on how to stretch tight muscles in order to improve flexibility and range of motion; patients, in turn, can perform these exercises on their own at home
• Pain-relieving modalities: ice, heat, uasound, and other passive interventions may also be used to reduce pain and inflammation

Plantar fasciitis

• Stretching and strengthening exercises: the primary muscles targeted are those of the calves, ankle, and foot, including the plantar fascia
• Foot taping and/or a night splint: these techniques provide support for the arch of the foot
• Footwear education: as with Achilles tendinitis, your footwear selection can affect the progression of plantar fasciitis, and your therapist can guide you on how to select the right pair of shoes that reduce stress to the plantar fascia
• Pain-relieving modalities: heat, uasound, and icing the bottom of the foot can all lead to immediate pain relief
• Manual therapy: massage and manual techniques can release muscle tension in the foot and surrounding area and reduce pain

With a clear set of benefits and a treatment approach that will be unique to your condition, physical therapy is the fastest and safest way to a complete recovery. So if you’re bothered by any lingering pain in your lower leg, contact a physical therapist to get started on your rehabilitation right away.