Your potential "Why" to your back/hip pain:

  • The “why” might take a little longer to discover and your homework and awareness over the coming weeks should help provide more information. Here are some things we found that might be contributing:

  • Low back and hip musculature are all tight, obviously. The questions is “why”? As discussed, maybe the core is not working during movement like it should and we need to coordinate the core turning “on” and the rest of the hip, buttock, back muscles turning “off”. This might be the start of the treatment program focus as a few things we did on our first visit does point in that direction.

  • Despite the “core” feeling strong, there are some other more advanced core assessments we can do to check other core “lines” that I will explain later.

  • As mentioned at our first visit, there could be some of the “pyschosocial” aspects to the pain that can also be addressed. The stretching x20 per day not only is helping physically, but also can be used as a mini “meditation” to help quiet the mind.

  • Another thing to take a look at is leg length and how the body is adsorbing the weight bearing load when you take a step. Since the pain started from running, there might be some ankle and knee things going on that we can check out.

  • We will continue the keep the mind open for new “whys” as we work through the program.

Update after 3/28/19 Visit

  • To continue helping with finding the “why”, I will just make a few notes here. Mobilization of the low back did not reproduce the pain symptoms like they did last visit and the “back muscles” (paraspinals) seemed to be looser today. Posterior hip/buttock muscles seemed to be very tight and pressure point therapy to this region as performed at today’s visit, seemed to loosen the area up and drop the pain one point. Core seemed strong as last time and when able to turn “off” the “back muscles” pain came down slightly. Engaging the “posterior chain” with the manual pull and then exercise ball exercise dropped the pain a little. What does all of this mean. I get this gut feeling that the entire core and trunk area is unable to orchestrate the proper muscle firing to allow you to move in a good pattern. This is supported from you stating that it is hard for you to “feel” or “understand” what you body is doing at any given time. The idea of getting the deep core muscles to fire and turning “off” the superficial muscles (which overfiring of them could be the source of the pain), I think can still be a good working hypothesis. The gym ball exercise given today that seemed to help, could be the start of getting the body to work on concert to allow for proper movement. It might not be necessarily a “weakness” thing, but just a “lets get everything firing correctly” or a “motor control” thing. I also don’t think the “non-physical” components are playing any huge role as we discussed, but something that can still be discussed to possibly help bring your brain’s perception of what is going on down, which could help reduce your pain. I hope this is making some sense to you. See if you can get more pressure point to the buttock treatment in including maybe a hot pack to the area along with the new ball exercise. Call, text, or email if you need anything. Consider listening to a few of the Pain Reframed podcasts. Thanks Lori

Update from 4/25/19

  • Exercises overall still are appropirate. Nice job getting them all in! Changed “foam roll” exercise to “gym ball” exercise with the hope for a better exercise progression. Emphasized the “posterior plevic tilt” during floor core exercise to ensure core is engaged and body is not being placed in “arched back” position. Assessment today discovered new possibly major contributor to back challenges, which was the weakness or inability to fire the “anterior chain” muscles including the front abdominal muscles. This would be why the planks for you are so hard and why a modified plank exercise was given. The low back “lie on top of pillow” stretch discussed was also given today to help stretch back out of the “arch” position. The addition of “imagery” activity was also added, which was to take 5 mins per day with your eyes closed and imagine you are running in a normal and healthy way. Updated your home program below.

Home Exercise Program

 
 
I couldn’t find a picture of someone doing this is bed, but the plan from last visit was to use the foam roll and several pillows to get a similar effect as you see in the picture. The ball could be used, but I want more of a fulcrum at the low back, not at the hips (Hips bend find, that is whey the “touch your toes” activity can be done, because you are not bending the low back). I would try for a 10 minute stretch daily at least, if not twice per day. Just a gentle stretch, no “pain pain”.

I couldn’t find a picture of someone doing this is bed, but the plan from last visit was to use the foam roll and several pillows to get a similar effect as you see in the picture. The ball could be used, but I want more of a fulcrum at the low back, not at the hips (Hips bend find, that is whey the “touch your toes” activity can be done, because you are not bending the low back). I would try for a 10 minute stretch daily at least, if not twice per day. Just a gentle stretch, no “pain pain”.

 
Knee to Opposite Shoulder Stretch, same rules as above x20 per day

Knee to Opposite Shoulder Stretch, same rules as above x20 per day

 
When walking, try to be more fluid and aware of the “core” working, but turning off the back muscles. It will be tough, if you get frustrated, just stop and work on your stretches.

When walking, try to be more fluid and aware of the “core” working, but turning off the back muscles. It will be tough, if you get frustrated, just stop and work on your stretches.

 
Core exercise with marching at several reps as able. Reminder to keep low back flat (posteriorly tilted). If it comes up, it can increase discomfort and promote “arching”, which we are trying to change.

Core exercise with marching at several reps as able. Reminder to keep low back flat (posteriorly tilted). If it comes up, it can increase discomfort and promote “arching”, which we are trying to change.

Modifed Planks to be done on knees and to strengthen Anterior (Front of body) Chain (not full plank with knees off the ground, this is too hard for right now). Try to hold for 10-30 sec or longer as able. Position self with buttock a little higher than the straight line I tried to demo last week, but for sure try to flatten the back! Don’t let back “arch” and belly fall to the floor. I think this might be a big one to make a huge difference. Hope to progress to full plank when ready and stronger.

Modifed Planks to be done on knees and to strengthen Anterior (Front of body) Chain (not full plank with knees off the ground, this is too hard for right now). Try to hold for 10-30 sec or longer as able. Position self with buttock a little higher than the straight line I tried to demo last week, but for sure try to flatten the back! Don’t let back “arch” and belly fall to the floor. I think this might be a big one to make a huge difference. Hope to progress to full plank when ready and stronger.

Take 5 Minutes daily, close eyes and imagine you are running without any issues. This can be the start of the “graded activity” (carrying groceries example)

Take 5 Minutes daily, close eyes and imagine you are running without any issues. This can be the start of the “graded activity” (carrying groceries example)

Continue to regular workout as you have been doing. Good luck

 
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Call with any questions

303-915-5092

DrE@averyphysicaltherapy.com

 

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