There are a variety of problems and pathology that cause low back pain. These range from joint inflammation, soft tissue and facial tightness, disc herniation, degenerative disc disease, stenosis and lumbar nerve root inflammation or impingement.
Low back pain is second only to the common cold as a reason for doctor office visits in the United States. Why is low back pain so common? Today’s jobs and functional activities are contributing to worsening posture and body mechanics, causing increased load and stress to the spine.
One common pathology we see here (but it doesn't account for all of our back pain patients) is Degenerative Disc Disease, or DDD. It is the process of losing disc height. The inner most part of the intervertebral disc, called the nucleus pulposus, loses fluid and often small cracks or fissures develop in outer annulus of disc.
DDD is not necessarily a "normal" process of aging, but a common process. It is often a progression of previous disc herniation or bulge, but can occur at the same time. DDD can occur in individuals as young as 30 years old, and into 90 years of age.
Common Symptoms of DDD include :
How do we treat back pain?
All current research concludes that the only long-term effective treatment for low back pain of all pathologies is therapeutic exercise. Other modalities, such as massage, joint mobilization, or electrical stimulation are not strongly supported by research at this time.
So what is therapeutic exercise? It is exercise which helps to facilitate support and healing of the injured tissue. The specific exercises prescribed must be related to the type of pathology or structure creating the low back pain.
Pilates has become one of the most commonly prescribed therapeutic exercise treatments for low back pain. The movement principles of Pilates align with what allows for the extremely efficient healing of low back pain.
The Principles of Pilates:
Our clients feel the benefits early on in their program, and most often continue working with us even after symptoms have resolved. Our physical therapists and pilates instructors work together to continue tailoring your exercise program. We grow alongside you at every step of your journey.
Our primary goal is to allow our clients to heal and return to a fulfilling, pain-free lifestyle.
Below is a brief video of intermediate level core exercises generally safe for most low back conditions. However we strongly encourage you to meet with us for an individual evaluation, so exercises can be tailored specifically to your spine condition.
Are you menopausal, perimenopausal, or postmenopausal?Have you had a recent bone density scan?
Osteopenia & Osteoporosis are becoming an epidemic in our society. Millions of women (and men) have these conditions without knowing it. This is because these are “silent” conditions which often do not exhibit symptoms, and therefore are not addressed properly or in a timely fashion.
What is Osteopenia & Osteoporosis?
Osteopenia is a condition where bone mineral density is lower than normal. Its defined as a bone mineral density score between -1.0 and -2.5, and is considered by many doctors to be a precursor to osteoporosis.
Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density which can lead to an increased risk of fracture. Osteoporosis is defined as a bone mineral density score of -2.5 standard deviations or more below the mean peak bone mass. Medication is typically indicated.
What are the risk factors for these conditions?
What are the complications of these conditions?
Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury. In some cases, spinal fractures can occur even if you haven't fallen causing back pain, lost height and a hunched forward posture.
How is Osteopenia & Osteoporosis treated?
Treatment varies considerably among physicians and practitioners, but usually includes hormone balancing, exercises specific for bone health, a healthy diet rich in calcium, vitamin D and magnesium, and bone building supplements or medications.
Exercises which improve posture (decreasing round back kyphosis position), strengthen the spinal muscles and hip muscles in particular.
Balance exercises are also important to decrease fall risk, and potential fracture related to falls.
Below is our video of exercises beneficial for bone density.
If you have been diagnosed with Osteopenia or Osteoporosis, we can design a fitness plan for you that will keep your strong, stable, and safe.
Give us a call to book your first appointment.
Shoulder pain often creeps up on us after waking from a full night's sleep on your side.
A very common cause of shoulder pain is from a condition called "impingement syndrome."
In this condition, the shoulder bursa (subacrominal bursa) or one of the rotator cuff tendons (the supraspinatus), or both, are essentially being impinged or compressed within the shoulder (under the acromial arch) as we lift our arm overhead.
Daily activities, such as washing your hair, lifting laundry or groceries, or reaching upward and outward, can become painful.
How is shoulder pain treated?
The good news is this is a very treatable condition. As physical therapists, we will often perform hands-on manual therapy to soft tissues, which appear restricted (such as the latissimus and pectoralis muscles.)
We will also treat strength deficits in your shoulder blade (scapula) and shoulder (glenuhumeral joint) muscles.
To properly assess your condition, we will need to do an evaluation and subsequently prepare a plan of treatment and rehabilitation.
What is the sacroiliac joint? And why is it causing pain?
Have you ever heard of your Sacroiliac Joint? Most people haven’t unless a physician, chiropractor, or physical therapist have told them that it is the structure causing their buttock or back pain.
The sacroiliac joint is the connection or junction that connects your sacrum to the ilium pelvic bone. It is a strong joint that supports the entire weight of the upper body. It has a small amount of movement, and can sometimes become misaligned. When this happens, it can cause a lot of pain.
Many people who have lumbar low back pain due to disc and other issues, may also have some sacroiliac (SI) symptoms. SI dysfunction occurs in about 75% of people with low back pain.
How do we treat SI joint dysfunction?
If you think you are experiencing Sacroiliac pain, please know that it can be treated. We are here for you. Upon initial evaluation, we will determine what type of sacroiliac misalignment you have, and correct it. Our focus will then shift to maintaining the alignment with specific pelvic stabilization exercises that address your muscular imbalances. Treatment sessions are 50 minutes. The amount of treatment sessions will vary between 4-12 visits, depending on your condition.
First we need to align the joint. There are different techniques to do this. Oftentimes, a physical therapist or chiropractor will manually align the joint for quick relief. In order to keep the sacroiliac joint aligned, the pelvic muscles will need to be stabilized. Therefore I often teach self alignment techniques to patients that they can do on their own in between sessions. This video is an example.
Our focus will then shift to stabilizing the joint to maintain the alignment. We do this through pelvic stabilizing exercises and strengthening muscles, such as the glutes, transverse abdominis, and obliques. Treatment sessions are 50 minutes. The amount of treatment sessions will vary between 4-12 visits, depending on your condition. Below are a few examples:
If you think you are experiencing sacroiliac joint pain, you can schedule an evaluation with us by calling (408) 335-6670.
Many women suffer from symptoms that they believe to be “normal” after a certain age. However, we now understand that isn’t necessarily the case, and pelvic floor dysfunction can be diagnosed and treated.
Common pelvic floor dysfunction symptoms include:
What causes pelvic floor disorder?
Although we don’t really understand causes, we can link pelvic floor dysfunction to many factors which include:
How is pelvic floor disorder diagnosed?
A common diagnosis for pelvic floor dysfunction that we often treat, before or after surgery, is pelvic floor prolapse.
A prolapse occurs when the pelvic muscles and other supporting tissues become weak, which causes the organs in the pelvis to drop or fall out of place.
We also see patients who do not have prolapse but complain of some of the above dysfunctional symptoms. We recommend these patients see a specific internal pelvic floor physical therapist in addition to us working on the imbalances externally in their hip and pelvic musculature.
How is pelvic floor disorder treated?
At Pilates Sante, we will begin with an initial evaluation, to assess your trunk, abdominal and hip muscles mobility and strength. At your first appointment, we will create a home exercise program for you. You will be given exercises to do at home in between sessions that directly address your imbalances.
Within your second or third session, you will begin working on the various pilates equipment machines to address the same imbalances. Pelvic floor disorders or conditions can be treated from 2-20 visits depending on the condition and the client. We find pilates mat and equipment based exercises extremely transformative for pelvic floor conditions.
Patients and clients often come to us stating that they have “poor “ posture which they would like to fix. They point out to me that they feel they are slouched and their shoulders are rounded forward. In actuality when we evaluate their standing posture they often have quite the opposite postural fault. We see a very flat neck (cervical spine) and mid back (thoracic spine), with excessive muscular tension resulting… So what causes this type of postural issue?
Often we over correct our posture. We feel fatigued in our back muscles and try to prevent "rounding over or slouching", so we compensate by creating an overly erect “military “ type posture, particularly in standing. The problem with this military posing, is excessive straightening of the spine reduces or eliminates its natural curves. These spinal curves, which are lordotic in the cervical and lumbar spine, and kyphotic in the thoracic spine, are what allow the spine to be able to absorb gravitational loads. These curves convert the spine into a flexible spring rather than a rigid rod. Reduction of spinal curves increases the compression upon the intervertebral segments and discs which can eventually contribute or lead to conditions such as degenerative disc disease and arthritis.
Faulty posture symptoms include pain, soreness and intolerance to stationary positions, lifting activities, and general daily functional activities.
Treatment must be directed to restoring the natural curves of the spine with postural education, and therapeutic exercises. This frequently includes spinal mobility and stability exercises, stretching and strengthening exercises to address muscle tightness, weakness, and proprioceptive deficits.
Here are photos of poor "military" posture and better posture with my somewhat flat curves being restored .
My current program to improve my posture is:
1. Postural awareness: drop sternum to the horizon, allow upper back to round into neutral kyphosis, draw shoulder blades slightly together.
2. Cat/cow: focus on flexion or rounding of my upper back to increased thoracic kyphosis.
3. Scapular muscles strengthening: band pull backs, rows, and chest flys to strengthen the lower trapezius and serrates anterior.
If any of you are interested in a refresher on your standing postural faults, don't hesitate to schedule a fitness evaluation with one of the excellent pilates instructors orphysical therapists at Pilates Sante.
Ariel Lehaitre MSPTPIlates Sante Owner/Founder
Pain. At some point in our lives we will experience pain. Whether it be physical, emotional, or both. The fact that the experience of pain can be so drastically different from one individual to the next, has created a lot of inquiry in the medical field.
Since I graduated from physical therapy school (over 20 years ago now ) the definition of pain, how it manifests, and how to treat it, has completely evolved and changed. We once thought pain occurred when an apparently noxious stimulus occurred in our physical body creating a direct response to the output experience of pain. What we now know is that the process of pain development is much more complex. It is still agreed that a noxious or uncomfortable stimulus often occurs to start the process, however the signal is then set to the brain which interprets how to respond to this stimulus.
Therefore the same type of stimulus response can vary dramatically from one person to the next, based on the brain's process. For example, if I've experienced a history of pain in the bottom of my left foot and I then step on a sharp object, my experience of that pain will likely be quite different from a person without this previous foot “trauma.” It is also proven that other factors will directly impact the degree of pain they report, such as the state of one’s nervous system and the amount of stress a person is experiencing.
This newer model of understanding pain is termed the BioPsychosocial Pain Model. It explains that pain is created by the brain directly, and this process is impacted by multiple factors. It confirms that pain is not the direct result of body tissue damage, particularly in chronic pain. Instead, chronic inflammation is often causing or contributing to the chronic pain. Fear, and other negative emotions, can directly increase inflammation contributing to chronic pain. The natural healing “pharmacy” of the body in the calming parasympathetic nervous system state is inhibited when stress, fear, and negative emotions are high.
So with this new information, how can we modify how we treat pain as physical therapists or rehabilitation practitioners? We can provide techniques to help our patients or clients transition from the sympathetic nervous system's limbic state of stress and fear to the parasympathetic nervous system's calm and healing state. There are many tools to do this such as mediation & mindfulness; see our Stress Management page, energy work such as Reiki or EFT tapping (emotional freedom technique), in addition to the assistance from other practitioners such as acupuncturists and psychologists.
If you’d like to learn more about pain and the Biopsychosocial pain model, here are a few good resources:
David Butler and Lorimer Moseley's Explain Pain
Adriaan Louw's Why Do I Hurt?
Greg Lehman's Recovery Strategies
The Back Pain Podcast with Rob Beaven & Dave Elliott
The gut microbiome refers to the “ecosystem” that lines your intestines. This includes more that 100 trillion microbes consisting of bacteria, fungi, and viruses. Gut Microbiota refers to the “good bugs” which are beneficial organisms that exist to create and support our immune system, therefore protecting us from disease. In fact, functional medicine doctor, Dr. Mark Hyman, believes the gut microbiome may be one of the most important regulators of our overall health. Researchers are now finding that imbalances in the gut bacteria can lead to an enormous amount of disease including (but not limited to) cancer, arthritis, autoimmune disease, cardiovascular disease, neurological diseases, depression & other mods disorders, chronic fatigue and pain. Gut microbiota are so powerful that they will modulate what’s termed the “gut-brain axis” which enables them to influence the brain function and therefore pain sensation.
So what contributes to poor gut health, and why do so many of us suffer from gut problems or issues?
Healing our gut, can not only prevent us from chronic illness and disease, but will directly decrease the chronic inflammation causing our pain!
So how do we heal our gut?
I highly recommend working with a functional medicine doctor, naturopathic doctor, or very skilled nutritionist to determine which specific gut imbalances you may be suffering from. However, there are some basic steps you can take independently to begin.
Some of Mark Hymans tools to heal your gut include ;
Most often, supplements will also be needed to properly restore the balance of our GI tract. Here are some of my favorites from Designs for Health:
*The gut-brain axis (GBA) consists of bidirectional communication between the central and the gut or “enteric” nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions.
When we are dealing with chronic conditions or pain, we occasionally have flare ups. There may be a mechanical reason for increased pain, such as prolonged sitting for low back pain or sleeping in a poor position for cervical pain. Other times, there may not appear to be a specific reason for increased symptoms, which can be frustrating! Either way, there are steps you can take to feel empowered to control your pain. Below are a few steps to help manage pain and inflammation:
Remember that flare up in symptoms are temporary, and the body can heal and recover! We are here for you, and are deeply grateful for you trusting us with your care!
“Your body’s ability to heal is greater than anyone has permitted you to believe.“
Pilates Santé Owner & Physical Therapist
What is Pilates?
Pilates is an increasingly popular form of exercise for people of all ages and fitness levels. It is a low impact, versatile, and effective option for people wanting to improve their strength, posture, balance, flexibility and muscle tone. Pilates exercises focus on strengthening the lower abdominal muscles and pelvic floor, providing a ‘stable core’ that supports the back and allows efficient movement. Exercise programs can be extensively modified to focus on different body parts and accommodate individual needs. Exercises can be performed on a mat or with resistance provided through Pilates equipment known as ‘reformers’ and ‘trapeze tables’, and other smaller equipment such as exercise balls and resistance bands.
Pilates for Labor Preparation
Why is deep breath so important in labor? How can a calm inward focus change your birth? A woman who is in tune with her body and her physical capabilities will have a much more empowered labor. It is not necessary to tell a laboring woman when or how to breathe if she is already breathing deeply and directed her intention with her breath, which is learned through the pilates method. A pilates client in labor will probably not need to know when to push or for how long. She will simply push when her body tells her to because she has learned to listen. Certified professional midwife Stacey Haugland notices very positive effects of pilates during births.
How does pregnancy affect the abdominal muscles, back and pelvic floor?
During pregnancy, the abdominal (tummy) muscles are stretched to make room for the growing baby. This may weaken the muscles, particularly the deep abdominal muscles. Deep abdominal muscles are responsible for providing support to the back (working like a corset). Lack of support makes the back vulnerable to injury. This is made worse by the hormone relaxin, which is released in pregnant women to soften the ligaments and allow the pelvis to stretch during delivery. All ligaments are softened by relaxin, including the ones in the back. With reduced support from ligaments and abdominal muscles, many pregnant women experience back pain. Relaxin remains in the body for some time after the baby is born. It is therefore important to protect the back not only during pregnancy, but also after birth, particularly when lifting, bending, breastfeeding, etc.
The pelvic floor muscles are responsible for controlling the bladder and bowel. They are weakened as they stretch and hold the weight of the growing baby. Weak pelvic floor muscles can result in difficulty controlling the bladder or bowel (incontinence) and can impact on sexual function. For example, some women find they leak urine when they cough or sneeze (stress incontinence). Around 46% of pregnant women in Australia experience urinary incontinence, and 30% have ongoing problems after delivery.
Is Pilates useful in pregnancy?Pilates is an ideal exercise during pregnancy as it is designed to strengthen the deep abdominal and pelvic floor muscles. Strength in these areas is known as ‘core stability’. These exercises can be performed in positions that are suitable for women at all stages of pregnancy, such as on hands and knees. Such exercises may take the stress off the back and pelvic floor, and help position the baby for delivery. Pelvic floor exercises have been shown to reduce urine leakage in women with stress incontinence and women who have to rush to get to the toilet on time.
Is Pilates safe in pregnancy? It is important to check with your doctor or midwife before starting any new exercise program during pregnancy. If you have not done Pilates before pregnancy, it is essential to receive input from a Pilates instructor or physiotherapist in a setting where you can receive individual attention. Do not attempt exercises on your own until a professional has assessed your performance.
Certain exercises are no longer appropriate from mid pregnancy onwards due to the positions they require (e.g. lying on your tummy or flat on your back). However, exercises on hands and knees, in sitting, and in kneeling positions are all likely to be safe. As your pregnancy progresses the muscles become more stretched, and it may become more difficult to achieve good contractions.