Imaging for first-time lower-back pain may be unnecessary. It might not reveal the cause, and could also complicate treatment. According to Max Wintermark, MD, chief of neuroradiology at Stanford University, "if you take 100 random people and do an MRI [magnetic resonance imaging] of their lumbar spine, a number of people without pain will show the same abnormal findings as those with pain." One study found that 81 percent of adults with no symptoms showed a bulging disk. 
Finding an abnormality doesn't mean it's the source of the pain, and treating based on scan results might lead a patient down a road of potentially unhelpful interventions, including surgery.
At best, imaging results likely will not change the treatment recommendation:
                           In many instances, doctors will prescribe
​                    physical therapy no matter what a scan reveals. 

I was recently on a return leg to California after spending the week in Washington, DC on a business trip. Since most of the business related to the way physical therapists can help people return to doing the things they love is in a low-cost, non-invasive way, I was still seeing through that lens while flying over the Potomac River and back home. To kill some time, I thumbed through the Southwest Airlines magazine and was struck by the contrasting messages of the articles and the ads of the magazine.
Naturally, the articles promote traveling for sports events, exotic cuisines, and relaxing vacations. Each weaves a story of adventure and paints a picture of experiences that can only be had in specific locations around the globe. These ads feature magical destinations aimed at exceeding expectations and encourage readers to be active thrill-seekers and explorers of the world and it’s many cultures. Simply put, the articles focused on our ability, when healthy, to live life to the fullest.
Maybe it was because we were thousands of feet above the ground, but I found it easy to keep my head in the clouds and picture my family and I discovering ancient Aztec ruins, walking on a beach in the Caribbean, and skiing Jackson Hole, Wyoming. Then, with the turn of the page, my head snapped back to reality with whiplash like force. I had spotted a reminder of why my parents and millions of others around the country would have to settle for dreams rather than authentic experiences. I spotted a medical advertisement.
You know the ones I’m talking about. It’s those ads using the smiles and confusing credentials of the surgeons to sell invasive, expensive, and generally unnecessary surgical ‘cures’ for chronic low back pain, joint pain, and rotator cuff tears. There’s no mention of success rates or the months of rehab required following the surgery, and all seem to be the ‘best’ or ‘only’ choice in dealing with your pain. Unfortunately, these ads redirect the focus from dreams to disability. To those with pain, they say ‘remember that your pain will prevent you from living life.’ To those who have already had a surgical procedure, they say ‘after paying the insurance deductibles, you can’t afford to take such a vacation’. However, among the disappointing medical ads, there was one ray of hope that offered a meaningful, low cost, and non-surgical solution to all of this. It came from the unified message of the California Physical Therapy Association- “Physical Therapists Improve the Way You Move.”

Research shows that receiving physical therapist services have the same (if not better) success rates compared to surgical options for neck, shoulder, low back, and knee pain. And it does all this with significant cost savings to you in a shorter amount of time! Seeing a physical therapist should be the first option to get rid of pains related to nerves, muscles, and bones. In all 50 states, consumers are able to access physical therapists directly, meaning that you don’t have to see a doctor for a referral to physical therapy.
With the help of a physical therapist, you’ll be able to manage your pain in less time and less cost to you. Keep dreaming of those vacations! 

Post Courtesy of Matt DeBole, an Outpatient Orthopedic Doctor of Physical Therapy at Palo Alto Medical Foundation.

Making healthy lifestyle choices in early adulthood can build a higher peak bone mass, and reduce your risk of osteoporosis in later years. These choices may lower your risk of falls and improve your overall health if you adopt them at any age. Keeping physically active helps your reflexes stay sharp and your muscles stay strong, and that can help with coordination and lower your risk of falling. If you're fit, your balance is better, and that makes you much less likely to take a fall than someone who has become bedridden and infirm.

​Aside from improving your balance and strength, exercise also has a direct impact on the strength of your bones. Bone is a living tissue. Like muscle, it weakens if you don't exercise it. By staying fit, you can make your bones stronger and less likely to break during a fall. Experts generally recommend a combination of weight-bearing exercise (like walking), resistance exercise (like lifting weights), and flexibility and balance exercises (like yoga or tai chi). However, a note of caution: always talk to your doctor before starting up an exercise routine. ​

Weight-bearing Exercises: 
These exercises include activities that make you move against gravity while staying upright. Weight-bearing exercises can be high-impact or low-impact.

​High-impact weight-bearing exercises help build bones and keep them strong. If you have broken a bone due to osteoporosis or are at risk of breaking a bone, you may need to avoid high-impact exercises. If you’re not sure, you should check with your healthcare provider.
Examples of high-impact weight-bearing exercises are:

• Dancing
• Doing high-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis

Low-impact weight-bearing exercises can also help keep bones strong and are a safe alternative if you cannot do high-impact exercises. Examples of low-impact weight-bearing exercises are:

• Using elliptical training machines
• Doing low-impact aerobics
• Using stair-step machines
• Fast walking on a treadmill or outside

Muscle-Strengthening Exercises
​These exercises include activities where you move your body, a weight or some other resistance against gravity. They are also known as resistance exercises and include:

• Lifting weights
• Using elastic exercise bands
• Using weight machines
• Lifting your own body weight
• Functional movements, such as standing and rising up on your toes

Flexibility and Balancing Exercises 
These moves don't directly strengthen your bones. They can, though, improve your coordination, flexibility, and muscle strength. That will lower the chance that you'll fall and break a bone. You can do these every day.
Balance exercises such as Tai Chi can strengthen your leg muscles and help you stay steadier on your feet. Posture exercises can help you work against the "sloping" shoulders that can happen with osteoporosis and lower your chances of spine fractures.
Routines such as yoga and Pilates can improve strength, balance, and flexibility in people with osteoporosis. But some of the moves you do in these programs -- including forward-bending exercises -- can make you more likely to get a fracture. If you're interested in these workouts, talk to us at The Smith Clinic and we can tell you the moves that are safe and those you should avoid.

Make an appointment today for an evaluation so we can recommend the best treatment plan for you! 901-756-1650. 

Whether you are stuck in the office or traveling this week, these easy stretches are great for helping to ease muscle tightness and stiffness. Sitting for longer periods of time, or sitting in different positions than normal, can often cause you to have pain in areas that you might have not had in the past. Incorporate these into your day, and help avoid the pain! 

1 - Neck & Shoulder Rolls With Closed Eyes
Benefits: Rests the eyes which prevents eye strain; lubricates and stretches the neck joints; relieves tension in the neck, shoulders, and upper back
The Pose: Begin by sitting on the edge of your seat with feet hip width apart and flat on the ground. Extend the crown of the head toward the ceiling creating an elongated spine. ​ Inhale deeply. Exhale and allow the eyes to close. Inhale, lengthen the spine and slowly lower the right ear to the right shoulder. Exhale, lowering the chin to the chest. Inhale, lifting the left ear to the left shoulder. Exhale, lowering the chin to the chest. Repeat five times with the eyes closed. Inhale, roll the shoulders forward and up to your ears. Exhale, rolling the shoulders back and towards the floor, allowing the shoulder blades to slide down the back. Repeat five times in both directions.

2 - Chair Twists
Benefits: Whittles the waist by trimming inches; stretches the spine, shoulders and hips; relieves lower back, neck and sciatica pain; aids in digestion; massages internal organs which pushes out toxins and allows the organs to refill with fresh blood.
The Pose: Begin by sitting on the edge of your seat with feet hip width apart and flat on the ground. Inhale, lengthen the head towards the ceiling. Exhale, twist to the right side bringing the left hand to the outside of your right leg. Place the right hand on the left side of the upright seat back. Allow the head to follow the twist of the spine and allow the eyes to gaze beyond the chair back. Inhale, coming back to center and repeat on the other side.

4. Eagle arms
Benefits: Work your upper body and release shoulder tension.
How to do it: ​Stretch your arms forward, parallel to the floor, and spread your shoulders wide. Cross your arms in front of your torso, so your right arm is above the left, and then bend your elbows. Snug the right elbow into the crook of the left, and raise the forearm perpendicular to the floor. The backs of your hands should face each other, and your right thumb should pass in front of the left hand’s little finger. Press your palms together, lift your elbows, and stretch your fingers toward the ceiling. After 15 to 30 seconds, unwind your arms, and repeat for the same amount of time with your arms reversed.

Unfortunately for most of us, the majority of our day involves sitting. When you drive – you sit. When you watch TV – you sit. When you have a desk job – you sit for eight hours straight. You would never guess it, but Many studies have shown that sitting for long periods of time can lead to some serious health effects. In fact, it has lead to the creation of the phrase, “sitting is the new smoking”.

What can you do to combat these effects?

• Every hour, stand up and walk around the office for a few minutes.


• Walk down the hall and talk to a co-worker instead of sending an email.


• Take the stairs instead of the elevator whenever possible.


• Use an exercise ball as your chair – this will help engage your abs and lower back.

                                                                      *      Use a standing workstation.

​Everyone knows that sitting for long periods of time is bad for your body and your mind. Getting the blood flowing helps you stay fresh with creativity, boosts energy and helps your body work more efficiently. Many of us don’t have the opportunity to get up and move around as often as we should. And some of us are wheelchair bound, or have injuries that have us temporarily unable to be more mobile. Here are a few simple stretches you can do while sitting to improve your mind and body.

Seated Twist
​Sitting in your chair while keeping a long, tall spine, place your right hand on the outside of your left knee. Use that hand as leverage to twist to your left, and place your left hand as far to the right as possible to have something to hang onto while you twist. Now join it with your breath. Exhale as you move into your twist, inhale as you ease off. Repeat on the other side. Repeat each side 2-3 times.

​Purpose: Stretches and lengthens the entire spine

​Sit upright in a chair, keeping your spine straight and holding your head erect.
Place your palms in your lap and relax your shoulders and arms.



Place your feet hip width apart. If this is not comfortable, you can place your feet farther apart, however, if you do so turn your toes slightly towards one another.​​


Inhale while leaning forward over your thighs. Allow your hands to dangle on either side of your feet, keeping your shoulders relaxed and your neck elongated.
      Breathe deeply into your lower back, holding this stretch for 20 to 30 seconds.                    
      Sit up slowly.

​1. Neck tension plagues many of us daily and contributes to stress and fatigue. A simple way to tone the lower facial muscles from your chin down through your neck, is a Stoplight technique:

• At a fresh red light, slowly turn as you exhale, looking over your right shoulder.
• Push out slightly through your chin.
• Keep the rest of your body facing forward and your hands rest, relaxed on the steering wheel.
• Hold for a few seconds and swing slowly to look over the left shoulder.
• If there's time, do 10 repetitions slowly.

Second stage:

• Make sure the light hasn't changed, then look over your right shoulder and up slightly, so you feel a good stretch though the neck muscles.
• Next, leading with your chin, drop your head down as you roll to the other side - slowly again.
• Check on the traffic and if there's time, repeat these rolls slowly 10 times.

2. Whenever you sit for long periods, and especially in a car, gravity takes its toll. It's harder for fresh blood to flow, to bathe your lower spine, inner organs, thighs and sit muscles; to cleanse and bring renewed energy. A simple way to work those lower muscles is with a slow squeeze and release:

• In a smooth motion, slowly contract your sit muscles - from your hips down through your thighs.
• Hold for a count of 10 or 15 and slowly release.
• Be sure to keep breathing and repeat often.

3. Working your tummy muscles with awareness and intent helps tone that area, while aiding digestion and elimination:

• Slowly squeeze in below your diaphragm (the muscle below your ribs)
• Hold for a 15 count and release slowly.
• Remember to keep breathing.
• Repeat 10 or so times a day to help keep your stomach muscles firm.

We hope everyone had a wonderful Thanksgiving filled with joy! The Thanksgiving, Christmas, and New Year’s Holidays are a great time of year for family and reflection. We spend time together and eat well-prepared food (hopefully!), talk, pray, and laugh as a family.
So why would anyone needs tips to help avoid pain during the Holidays?
First off, we’re talking about physical pain here. The demands of the Holiday season with all the shopping, lifting of boxes, standing while cooking, and general preparations can wreak havoc on the body if these demands are not performed properly or if you are weak in certain areas of your body. This weakness in certain muscle groups can cause muscle soreness or muscle pain, joint stress, and even minor injuries, because your muscles and joints are not accustom to being used in this way (or at all).
Maybe you remember last year’s back pain, neck pain, foot pain, ankle pain, hip pain, knee pain, or general headache associated with everything that you went through during the Holiday season. It doesn’t have to be a painful experience! 
“The added demands of the holidays stresses the body, which may increase the risk of injuries related to the extra activities,” says APTA spokesperson and physical therapist E. Anne Reicherter, PT, DPT, PhD. “Using proper body mechanics can help prevent muscle and joint discomfort this holiday season.”
So let’s look at some tips that you can use to truly help avoid pain during the Holidays:
Shop, Don’t Drop: Nobody is saying you can’t go shopping just because it might hurt your back, but just be smart about it! Hopefully you stayed safe during the Black Friday rush and didn’t suffer any injuries while being trampled.

• Try to do a little warmup before you get out in the chaos. Riding a stationary bike or doing some simple at-home exercises will go a long way.
• Stretch the muscles of your lower back, hamstrings, quadriceps, and calves to make sure these muscles are lengthened before you start shopping and walking long distances. Stretching these muscles will help prevent them from tightening up so much and causing muscle pain.
• Wear comfortable shoes. House slippers don’t count. Your shoes need adequate support. Think “tennis shoe”, not “high heel”. You’re going to be walking around on concrete more than likely.
• Always use a shopping cart and push it all the way to your car before unloading.
• It may be tough but try to find shopping times when the rush is as slow as possible. This will keep you from having to stand in line for long periods of time on hard ground.

Lift With Your Legs, Not Your Back: this is a tip physical therapists will always advocate. After you shop your bags, boxes, and presents are going to have to find a way into your house. Proper lifting and carrying form is crucial to avoid unwanted pains and injuries.

• If you have to pick up a box or group of bags off the ground, or even your trunk, focus on keeping your back straight and vertical while bending at the knees to grasp your items.Lift by simply straightening your legs. Your legs are much stronger than your lower back and much less susceptible to injury. The worst thing you can do is bend straight over at the waist with a rounded back (the same is true if you maintained a straight back at this point), kept your legs straight and then lifted the object with your lower back muscles. Even if you think the object is not heavy, don’t lift it this way.
• Keep the load close to your body when lifting it off the ground. An easy way to get hurt is to get the object out away from you.
• Make a few trips. Don’t try to be a hero and carry it all in one trip. This is a fast-track way to hurt yourself.
• Always call us if your back or neck pain last longer than 1 day or feels severe enough to need immediate help.

These simple tips will help you avoid pain during the Holidays. If you are experiencing muscle pain in any area of the body you feel needs the attention of a physical therapist, please don’t hesitate to call us today to come meet with either Michael or Chris for a thorough evaluation to help get the relief you need this Holiday season!