Spine injuries occur often in sports and athletic situations because of the increased forces and stresses put on the spine. Athletes are often in awkward positions when these forces occur, increasing the risk of significant injury. Causes Compression Forces – these are forces which push or squeeze the vertebrae together. Tackling head first or landing on the head are examples of situations that lead to this type of injury. Rotational Stress – the main two things that limit rotation of the spine are the facet joints and the discs. Repetitive rotational stresses can cause damage to both of these structures, as well as the ligaments surrounding the vertebrae themselves. These injuries can occur in any athletic situation, especially in golf, baseball, basketball or soccer. Pelvic Asymmetry – this typically comes from a fall or other trauma to the hips. The structures of the pelvis become misaligned, which can lead to spine involvement as well if not treated. This condition is common in many sports, especially contact sports. Forward Bending – this motion is the most common cause of any back or neck injury. This motion predisposes the discs to posterior stress, which significantly increases the chance of bulges and herniations. Add this stress to movements and activities which include large forces and loading, and it creates a bad recipe for injury. These are common in any athletic activity, including weightlifting and contact sports. Treatment Treatment will vary depending on the mechanism of injury and the specific signs and symptoms. Treatments should always focus on the mechanical cause of the pain and injury, instead of the pain itself. Be wary… Treatments that don’t address the mechanical causes of your condition may help temporarily, but won’t help long-term. Specific exercises are the only ways to address sports-related pain over the long term.

Pregnant women can experience low back, mid-back, pelvis, or neck pain. In addition to carrying more weight than your body is accustomed to, your endocrine system is releasing a hormone called relaxin, which will help your pelvis to stretch to accommodate childbirth. Although this is helpful for childbirth, it can cause significant increases in lower back, mid-back, neck or pelvic pain and asymmetry. Treatment A stabilization program gives safe relief from back pain during pregnancy. Some women also get some relief from SI belts or other methods of support. Heat and ice are the only home treatments you should consider. Be wary… Ultrasound and electric stimulation are sometimes contraindicated during pregnancy, depending on the location of the injury and the term of pregnancy. If used improperly, these treatments can cause complications, including premature labor. We are very careful to consider these factors when treating pregnant women.

Work can present unique challenges when experiencing lower back or neck pain because of the unique positions and activities presented in many job situations. Causes This pain is often caused by spending long periods of time in the same position or motion. Sitting – can increase stress on the discs increasing the probability of disc pathology (bulges or herniations). Standing – excessive standing can cause increased load on all of the structures of the spine, including the discs and facet joints, which can accelerate the degenerative processes of the spine. This can be worsened by standing on hard or concrete floors for long periods of time. Driving – this causes the same stresses as sitting, although the forces are worsened secondary to the vibration and bouncing associated with driving. Lifting – lifting heavy things can severely increase the load on the spine. Many times this is worsened by trying to lift objects in awkward and unbalanced positions, especially when lifting and twisting at the same time. Repetitive Movements – many jobs involve tasks with repetitive movements, which cause increased stress on one area in a certain range of motion. This leads to a wearing down of that area in that range of motion. Treatment Treatments will vary depending on the area affected and the signs and symptoms that are present. For neck and back problems see the Acute Low Back, Chronic Low Back, Acute Neck and Chronic Neck headings in this section. Be wary… Treatments that don’t address the mechanical causes of your condition may help temporarily, but won’t help long-term. Specific exercises are the only ways to address work-related pain over the long term.

Chronic back pain is pain that has been present for a longer period of time, possibly even years. Lower back pain is especially common, but sometimes leg, hip or buttock pain are involved. Causes Degenerative disc disease – changes in biomechanics in the spine cause disc pain, disc bulges/herniations, facet joint loading and stenosis. Stabilization muscle deconditioning – weakness in the stabilizer muscles such as the abdomen, gluteus medius, and trapezius can cause stress and pain in the back, hip, and shoulder. Changes in gait pattern can cause increased stress through the feet, knees, hips and lower back. Treatment Spinal decompression – unloads facet joints, decompresses discs, reduces disc bulges and herniations, stretches tight muscles and ligaments. Stabilization exercise with directional bias – exercises specifically for chronic lower back pain, which can halt the degenerative process, alleviate pain and increase function. Inflammation control – with heat, ice, and other passive treatments. Mobilization – exercises to improve segmental ROM and facet joint mobility. Be wary… Rehab that involves only passive treatment (modalities) and massage won’t make a lasting difference. Rehab that does not teach you how to manage your condition at home when you are not in the clinic keeps you dependent and doesn’t solve long-term problems with pain.

Acute Lower Back Pain is the first 24 hours to the first week of back pain. There may also be pain in the legs, hips or buttocks. Causes Annular Tears – tears in the outer 1/3 of the disc which increase the probability of disc bulges and herniations. Disc Bulge/herniation – an actual bulging of the disc in one area. Facet joint sprain or locking – partial tearing of the ligaments surrounding the facet joints in the spine, or facet joints actually locking or being limited in their normal motion. All of these conditions contribute to muscle spasms, since muscle spasming is the body’s way of protecting itself when something in the spine is injured or not functioning properly. Treatment Ice – always on acute injuries of any type. No Heat – causes increased inflammation in acute injuries. Directional Exercise – to reduce disc involvement and inflammation. Modalities (passive physical therapy) – to decrease inflammation and muscle spasming. Spinal Decompression – to decompress discs, reduce bulges, assist healing and ensure proper tissue reformation. Mobilization – improves and increases joint mobility in the spine including facet joints. Treatment should progress into a more specific exercise program for directional exercise and stabilization. Be wary… Medication can cover up the existing mechanical cause of your condition, and rehabilitation that doesn’t include specific and extensive exercising, plus instruction on how to manage pain when not in the clinic won’t solve problems of pain. Additionally, in cases of acute pain, there may be medical conditions (for example, annular tears) requiring early intervention to avoid chronic problems. If leg pain or changes in sensation occur, seek medical care.

Pain in the upper back or mid-back can radiate into the shoulder blades or chest. Causes Annular Tears – tears in the outer 1/3 of the disc which increase probability of disc bulges and herniations. Disc Bulge/herniation – an actual bulging of the disc in one area. Facet Joint Sprain or Locking – partial tearing of the ligaments surrounding the facet joints in the spine, or facet joints actually locking or being limited in their normal motion. Poor Posture – causing forward head, shortening of the anterior muscles of the neck and shoulders, lengthening and weakness of the posterior muscles of the shoulders and upper back. Subluxed Rib Heads – since the ribs attach to the spine and the sternum, certain injuries can cause a slight subluxation of the rib head at the spine leading to pain in the chest, as well. All of these conditions contribute to muscle spasms since muscle spasming is the body’s way of protecting itself when something in the spine is injured or not functioning properly. Treatment Ice – always on acute injuries of any type. No Heat – heat causes increased inflammation in acute injuries. Directional Exercise – to reduce disc involvement and inflammation. Stability Exercise – to increase upper back stability and postural stability. Modalities (passive physical therapy) – to decrease inflammation and muscle spasming. Spinal Decompression – to decompress discs, reduce bulges, assist healing and ensure proper tissue reformation. Mobilization – improves and increases joint mobility in the spine including facet joints. Postural Re-education – Treatment should progress into a more specific exercise program for directional exercise and stabilization. Be wary… Medication can cover up the existing mechanical cause of your condition, and rehabilitation that doesn’t include specific and extensive exercising, plus instruction on how to manage pain when not in the clinic won’t solve problems of pain. Additionally, in cases of acute pain, there may be medical conditions (for example, annular tears) requiring early intervention to avoid chronic problems. If leg pain or changes in sensation occur, seek medical care.

Chronic neck pain is pain that has been present for longer periods of time, possibly even years. Sometimes just neck pain, or sometimes shoulder, arm, hand, upper back and shoulder blade pain are involved. Causes Degenerative Disc Disease – changes in biomechanics in the spine causes disc pain, disc bulges/herniations, facet joint loading and stenosis. Stabilization Muscle Deconditioning – weakness in the stabilizer muscles such as the abdomen and trapezius can cause stress and pain in the neck and shoulder. Changes in posture causing forward head, tight anterior muscles, and overextended and weak posterior muscles and soft tissue structures. Treatment Spinal Decompression – unloads facet joints, decompresses discs, reduces disc bulges and hernitations, stretches tight muscles and ligaments. Stabilization Exercise with Directional Bias – exercises specifically for chronic neck pain which can halt the degenerative process, alleviate pain and increase function. Mobilization – improves and increases segmental ROM and facet joint mobility. Be wary… Medication can cover up the existing mechanical cause of your condition, and rehabilitation that doesn’t include specific and extensive exercising, plus instruction on how to manage pain when not in the clinic won’t solve problems of pain.

Acute neck pain is pain within the first 24 hours to one week. It is severe neck pain with possible pain into the shoulders, arms, hands, upper back, shoulder blades or headaches. This pain can be present with whiplash. Causes Annular Tears – tears in the outer 1/3 of the disc which increase probability of disc bulges and herniations. Disc Bulge/herniation – an actual bulging of the disc in one area. Facet Joint Sprain or Locking – partial tearing of the ligaments surrounding the facet joints in the spine, or facet joints actually locking or being limited in their normal motion. Treatment Ice – always on acute injuries of any type. No Heat – heat causes increased inflammation in acute injuries. Directional Exercise – to reduce disc involvement and inflammation. Modalities (passive physical therapy) – to decrease inflammation and muscle spasming. Spinal Decompression – to decompress discs, reduce bulges, assist healing and ensure proper tissue reformation. Mobilization – improves and increases joint mobility in the spine including facet joints. Treatment should progress into a more specific exercise program for directional exercise and stabilization. Be wary… Medication can cover up the existing mechanical cause of your condition, and rehabilitation that doesn’t include specific and extensive exercising, plus instruction on how to manage pain when not in the clinic won’t solve problems of pain. Additionally, in cases of acute pain, there may be medical conditions (for example, annular tears) requiring early intervention to avoid chronic problems. If leg pain or changes in sensation occur, seek medical care.

Causes Patellar Maltracking – A common cause of discomfort in the knee is when the kneecap tracks laterally (sideways) to where it is supposed to go. This causes increased friction on the back of the patella and the gradual wearing of the cartilage on the back of the knee cap. This condition is more common in women and in people with an increased angle from the quadriceps to the patellar tendon.(Q angle) Tendonitis – This condition arises from repetitive tasks which cause stress on the tendons surrounding the knee. The most commonly affected is the patellar tendon which is used to straighten the knee, and is called on in such activities as squatting, jumping, and running. Poor Exercise or Weight-lifting Technique – Poor body mechanics and form while exercising and lifting weights can predispose you to some conditions of the knee and other joints. You should correct form before lifting heavier weights, and progress in a gradual fashion instead of big jumps in resistance. Improper Hamstring Training – The hamstrings should be trained, not only as knee flexors, but also as hip extensors. Failing to train in this manner can lead to hamstring injuries, especially in sprinting and sports that require sprinting. Treatment Ice – Ice is always the first line of defense in knee conditions. This will help eliminate inflammation and swelling associated with most knee conditions. Ice should be applied for no more than 20-30 minutes at a time to avoid other complications. Stretching – Many times stretching the hamstrings and quadriceps will make a difference with tendonitis episodes when combined with ice; however, this condition often requires more involved care. However, stretching these muscle groups is good for general wellness and flexibility. Seek medical care if knee pain lingers more than two weeks, or if there is a significant increase in swelling and a worsening of signs and symptoms. Be wary… Knee pain usually has a mechanical cause, so passive therapies will have limited effectiveness. It is always important to look at the joints above and below the involved joint to determine their possible involvement in the condition.

Causes Pelvic Asymmetry – At times the pelvis can become out of alignment which can cause significant pain and discomfort. This can happen during a fall, or even just from stepping off a step wrong. If not corrected, this can lead to low back or even knee or foot pain and pathology. Weak and Tight Hip Musculature – The hip is analogous anatomically to the shoulder, although it has much more inherent stability. However, because of the constant stress it is under with walking, running, or other daily activity, the hip can begin to develop significant muscle imbalances which lead to significant pain. If not corrected, this can lead to further musculoskeletal pathology. Low Back Pathology – Hip pain can also be referred from the lumbar spine, especially with facet joint involvement. The extensors and external rotators of the hip can also become weak and atrophied in the presence of discogenic and degenerative conditions of the spine. Treatment Limit Walking – especially on uneven ground and hills. This can cause increase in pelvic asymmetry, as well as increased activity and spasticity of the hip musculature. Ice – Ice should always be used on injuries to limit inflammation and aggravation from daily activities. It is okay to alternate heat and ice as long as you always end with ice. Ice should be left on no longer than 20-30 minutes or a reverse effect can occur. Seek help from a professional if your signs and symptoms persist even with basic icing and rest. Usually, a basic therapeutic exercise program can alleviate your signs and symptoms and prevent further complication of the condition. Be wary… Hip problems that seem to extend down the leg can be caused by other pathology that can worsen without proper care. This is especially true in the presence of any muscle atrophy. Often in the case of hip pain, there can be contributory problems from other areas which only manifest in the hips. It is essential to check for other sources of biomechanical stress.

Physiotherapeutic Scoliosis Specific Exercise or PSSE has been practiced in Europe for approximately 90 years and has started to take hold in the last 15-20 years in the US as an option for non-operative treatment for scoliosis. Unfortunately, there are no completed randomized control trials to support the use of PSSE, but there are case studies that demonstrate improvement in overall posture, decrease in pain for those patients with pain, improvement in respiratory function and overall feeling of wellness. The NY Times featured Schroth therapy in a 2014 article, where Dr. Michael Vitale, chief of orthopedics at Morgan Stanley Children’s Hospital was quoted as saying “If you look critically at the body of literature, there is evidence that, when properly done in the right situation, with the right therapist and the right patient, Schroth can change the chance of curve progression.” There are several schools of scoliosis-specific exercise, most of which are either based on or borrow from the Schroth technique, described below. Schroth The Schroth technique was developed in the early 1900s when Katharina Schroth, who had scoliosis, was not happy with the treatment options available to her at that time. She wore a steel brace. She noticed the properties of balloons as a possible model for decreasing the degree of the curve on the concave side. Schroth’s idea was to breathe into the concave side while watching herself in front of a mirror. Schroth started a scoliosis clinic where she used functional exercises based on her experience in treating herself to treat and educate patients. By the late 1930s, the Schroth method was the most widely recognized for non-operative treatment of scoliosis. After World War II, Schroth and her daughter moved to West Germany and started a clinic there, where Schroth’s grandson, orthopedic surgeon Hans-Rudolph Weiss, later served as the medical director (until 2008). In 2009, Weiss branched out on his own to offer new bracing and therapy options that are based on the Schroth method. The clinic in West Germany continues to this day. Barcelona Scoliosis Physical Therapy School (BSCPTS, the approach practiced at ISR) The Barcelona scoliosis physical therapy school is a modified version of the Schroth method. Prior to 2009, the Barcelona school was a Schroth center. It was founded in the 1960s by physiotherapist Elena Salva who met Katharina Schroth and her daughter during that time while in Germany. The Schroths gave Salva a new perspective on scoliosis which she took back to her native Spain. For 40 years, she practiced the Schroth method. She then evolved the work into a mix of cognitive, sensory-motor and kinesthetic training. At the Barcelona Scoliosis Physical Therapy School, a slightly different approach from the traditional Schroth method is taken. Patients are taught to improve their own 3D scoliosis posture and shape using breathing and muscle activation techniques. The Barcelona school adheres to a “vicious cycle” theory which states that the scoliosis posture promotes progression of the curves. The primary goals of scoliosis specific exercises using the BSPTS approach are: Correction/improvement of scoliotic posture Prevention of curve progression Improve general health Improve respiration Address pain in patients with pain to diminish functional limitations The International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) includes PSSE as part of the standard of care for individuals with scoliosis. For more information visit their website at http://sosort.org.