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 Blue Hills Sports and Spine Doesn't 'Fall Back' with Outdated Approaches
November 2019        Issue # 105
'Leave' Behind Back 
Pain  this Fall
Fall is in full force and if you're a homeowner you might be dreadin g the manual labor that comes with the change of seasons. Whether it's lugging AC un its to the basement, raki ng up leaves, or preparing the garden for the winter frost, there's a lot of bending, lifting, hauling, and maybe even a few awkward positions and postures. We all know the conventional wisdom for these tasks -- squat down and lift with your legs, not your back, to avoid injury. A 2018 study published in Musculoskeletal Science and Practice found that 75% of physical therapists agreed that lifting with a straight back is safer as rounding your back is "risky," despite a lack of evidence that any specific spinal posture or movement increases the risk for low back pain. It's no wonder this misinformation is still so prevalent. 

Your back isn't as fragile as many of us seem to think. A great example of the robust strength and resilience of the spine can be seen with Cirque du Soleil performers who perform extreme and dangerous-looking stunts day in and day out. But are these stunts inherently dangerous? A 2009 study examining injury rates in these performers concluded that while injuries do occur, most are minor and do not result in missed performances. In fact, the occurrence of more serious injuries is actually lower than in many National Collegiate Athletic Association (NCAA) sports. Furthermore, a 2011 literature review of eight studies concluded that while occupational physical activity is often suspected of causing low back pain, the findings in all papers did not support this hypothesis with one study even concluding that more time spent flexing the spine beyond 30 degrees was linked with decreased back pain intensity.

So, what's the solution? Our body is highly adaptable and inherently strong thanks to years of evolution and adaptation. The gradual and greater variation in activity and movement we continue to show our body, the more it will continue to adapt. There are no bad movements, just ones you aren't prepared for. To get ready for this year's yard work and the upcoming winter shoveling, give our Lifting Conditioning Program a try (PDF Version). If you don't have weights at home or access to a gym, you can use a variety of household items to do these exercises, such as a basket of laundry, bags of groceries, or a case of water. 
Strengthening Shows Promising Results for Concussion Management and Risk Reduction
It's back to football season which means concussions and their treatment are a hot topic. A concussion is a type of traumatic brain injury caused by a bump, blow, jolt to the head, or hit to the body that results in a rapid back-and-forth movement of the head and brain resulting in neurological syndromes. It can take up to two to three days after injury for chemical changes within the brain to occur resulting in symptoms. Currently there are no objective ways to diagnose concussions or post concussion syndrome. 

Signs and symptoms that may present include headache or feeling of pressure in the head, temporary loss of consciousness, confusion or feeling in a fog, amnesia around the traumatic event, dizziness, ringing in the ears, nausea, vomiting, slurred speech, and general malaise. In most cases, people feel better after couple of weeks, and symptoms improve with time. However, if three or more symptoms persist for greater than four weeks this is known as post concussion syndrome. Risk factors for development include pre-existing learning disabilities, psychiatric illness, pre-morbid life stressors, and previous head injuries. Women and those of younger age are also at a greater risk. 

In October, our Boston office therapist Michelle Danley, attended the Concussion Diagnosis and Management Conference, which aims to highlight the current concepts and guidelines for diagnosis, medical management, and rehabilitation for these injuries. Research has shown that physical therapy, occupational therapy, and speech language pathology can be helpful rehabilitative tools in the recovery process  depending on patient's symptoms, presentation, and limitations. Additionally, physical therapy and strengthening exercise may even be beneficial from a preventative standpoint. A 2019 study showed a correlation between lower neck strength and neck girth with increased head acceleration during impact. Epidemiological studies have also shown a higher rate of concussions in female university athletes compared to their male counterparts while competing in comparable sports, which is believed to be related to these differences in neck strength and girth. Head over to our exercise portal for a Neck Strengthening Program that can help reduce the risk of concussions, or feel free to print our PDF version. If you think physical therapy would be helpful for you, head on over to our website to schedule an appointment
Snap, Crack, Pop! The Science of Spinal Manipulation Therapy
Neck and back pain are common ailments that in most episodes can resolve in two to six weeks, even without treatment. In some cases however, spine pain can lead to chronic pain, limited motion, and limited function. The economic burden associated with the management of neck pain in annual workers' compensation costs is second only to low back pain. One of the most common complementary health approaches used in treating this pain is known as spinal manipulation therapy (SMT).

Spinal manipulation is a technique performed by a practitioner such as physical therapists, chiropractors, osteopaths, and some medical doctors. In October, our Boston physical therapist Andrew DeStefano attended the spinal manipulation seminar hosted by the American Academy of Manipulative Therapy. In this seminar, practitioners were taught the foundations of these techniques where the provider uses their hands to apply a controlled, short and quick thrust to the spine. This results in multiple audible pops and cracks, known as a cavitation. Researchers have extensively searched for an answer as to what creates both the sound and benefits, but the exact mechanism remains unknown. Studies have hypothesized that SMT likely impacts afferent neurons that transfer sensory information to the brain about the surrounding tissues of the spine. This signal to the brain then alters the motor control system and pain processing resulting in less pain, better neck motion, and improvements in the ability to perform daily activities. 

Considerable attention has been given to spinal manipulation for the potential risk of injury or stroke from these techniques. However, there is robust evidence to show no additional risk for vascular compromise, stroke, or worsening of disk herniations associated with manipulation. Conversely, the strong evidence to support spinal manipulation therapy for the treatment of low back pain, neck pain, and cervicogenic headaches has led to its inclusion in the Clinical Practice Guidelines by both the American Physical Therapy Association and the American College of Physicians

Spine manipulation therapy should only be performed by a trained provider, however you can also try these Mobility Exercises (PDF Version) for spine stiffness to get things moving at home. Please note these exercises are not manipulations and therefore should not produce the associated cavitations. 
Curated and Edited by: Andrew DeStefano, PT (Boston Office)
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