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. 

At first when Patty had knee pain she would literally “shake it off.” But after a while, the pain in her left leg was
too much to ignore. Patty could barely walk.
Even standing was painful, which was problematic for a professor who needed to
stand for hours during classes.
Patty walked for exercise, enjoyed taking Zumba classes, and she had a trip to Europe planned. So when she learned that she had osteoarthritis, Patty felt “shocked, depressed, and old.” When an MRI showed degenerative meniscal tears, Patty wondered if she would be able to continue to do the things she loved.

Her doctor recommended physical therapy,
but Patty was skeptical.

“I knew others who had knee arthroscopy for their arthritic knee, I wondered if that was the way to go,” she said. “It could be a ‘quick fix.’ I didn’t understand how physical therapy would help my knee. Soon I learned that not only did I need an effective therapeutic treatment plan, but I needed to
be educated about arthritis.”

​Under the guidance of her physical therapist, Patty was educated about arthritis and worked on leg and hip strengthening and stretching, and on exercises to improve her balance. She continued her weekly cardio routine, making adjustments to be less damaging to her knees.

After 12 sessions, along with her home and gym exercise treatment plan, Patty made considerable progress. She could stand for hours—teaching without a problem—and she observed improvements in her strength, balance, and mobility. A few months later, Patty happily went
on her European vacation, walking as many as 6 miles a day without difficulty.
She also has walked two 5Ks with friends, and has more scheduled. 
Patty continues to improve. Occasionally she feels tightness in her calf, but now she
knows what exercises and stretches to do to relieve it.  
​
“I was a skeptic, but now I am a believer in the benefits of physical therapy,” she said. “In the end, I am glad that I didn’t have the arthroscopic surgery. Now, I have the knowledge I need to keep my knees as healthy and pain free as possible. And if needed, I wouldn’t hesitate to seek out the assistance of skilled physical therapists in the future.”    

Courtesy of moveforwardpt.com

Preparing for the Pool
Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. Here are some tips to get you started:

• Water shoes will help to provide traction on the pool floor.
• Water level can be waist or chest high.
• Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
• Slower movements in the water will provide less resistance than faster movements.
• You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
• Never push your body through pain during any exercise.
• Although you will not notice that you sweat with pool exercises, it is still important to drink plenty of water.

10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.
2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.
3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.
5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.
6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.
8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.
9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)
10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.
​
Credit: American Physical Therapy Association 

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.

Ageism is defined as stereotyping or discriminating a person or group because of their age. Here’s a quick test: What comes to mind when you think of an elderly person? How do you define the word old?
● Wrinkles?
● Weakness?
● Walkers?
● Frailness?
How you answer that question is very important as it guides how you interact with and care for someone that is elderly.
For example, if I associate old with frail, I may not let my grandmother carry her own groceries because I’m afraid she may hurt herself. In my mind, I’m caring for her. Yet, in reality, I may be robbing my grandmother of an opportunity to physically challenge herself and maintain (or even gain) strength.

What comes to mind when a physical therapist thinks of an elderly person? How do we define old?
● Strength
● Mobility
● Resilience
● Opportunity
Let’s use the grocery store example again. If I associate old with strength, I won’t stop my grandmother from carrying her groceries.  As rude as that may seem to some, I may actually be caring for her by encouraging her to be independent. She may be old, but doesn’t have to be weak!

Physical Therapists are in the business of redefining the word old. Physical therapy is the perfect profession for this task as we understand the changes that happen to the body as we age. Physical Therapists see elderly people and think of opportunity, not limitations. We work to get people strong, mobile, and able to do the things they want to do – regardless of their age.
I challenge you to consider how you define old. Do you associate being “old” with opportunity or limitations? Weakness or strength? Hope or despair?
As you or your loved ones age, consider physical therapy as your first stop to redefine what it means to be old. Seek the counsel of a physical therapist at The Smith Clinic for Physical Therapy to ensure you or your loved ones get “old” in the most desirable way possible.
Courtesy of getpt1st.com

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.