Why do I have a pain in my butt??!!

What do we treat the most at Missing Link Physical Therapy??!!!The pain in the butt!!! No, I don’t mean the client, but literally a pain in the butt sometimes referred to as sciatica or piriformis syndrome. Often individuals have difficulty standing, sitting, walking, running or going up stairs. This pain can be very debilitating and decrease function and quality of life. This blog is aimed to address ways to decrease pain and the necessary treatment required in order to regain your mobility and function.

Frequently when a sudden ache in the butt or leg occurs people always wonder, why? Individuals often don’t experience back pain and have not done anything differently to cause this pain. Well, the body is a great machine and was built to be resilient. Very often by the time you experience a particular pain the movement dysfunction has been present for years. It is like eating the wrong foods and years later you have hypertension and heart disease. In the majority of cases we can contribute the cause of the pain to a nerve irritation in the low back or peripheral muscles. For instance, with mild to moderate degrees of nerve irritation to the low back you can get this abnormal tightness and guarding of the hamstring, gluteal (butt) muscles, calf muscles and even heel pain or cramping of the bottom of the foot.

In order to start recovering from this state you need to remove the irritation to the spine. If the condition is acute this can be done by pharmacological means (please refer to your physician for the appropriate drug of choice). From a Physical Therapy disposition this can be done by avoiding certain postures; such as slouched positions, any activity that may place stretch on the hamstring (want to avoid stretching of the hamstring as it will cause stress on the nerve if there is nerve tension), reading in the bed with legs extended…Basically you want to avoid any position that will place stress on the nerve. Imagine a long string that is attached to your spine and extends all the way to your foot, every time you slouch or stretch the hamstring you irritate the nerve. The stretch may feel good initially but you will find that you may suffer a rebound effect of pain later in the day, with even more tightness in the particular muscle. Figure A shows an individual reaching into a box with a rounded back posture; this will increase tension in the back and also the nerve. Figure B shows an individual stretching the hamstring with a rounded back posture, at this time the nerve may be on maximal tension and irritation may be at its greatest. In Figure C the individual to the left is placing increased stress to the back and nerve, the individual to the right is exhibiting good technique with lifting by hinging from the waist and bending the knees.

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FigureA

hamstring stretch

Figure B

lifting

Figure C

After decreasing the nerve irritation it is now time to improve the muscle tension. This can be done by getting a deep tissue massage, foam rolling or trigger point dry needling (my recommended treatment of choice). You want to improve the muscle length of the gluteal muscles and back muscles. Figure D, E, F, H represent foam roll massages; these massages should be performed as tolerated, slowly kneading out the trigger points in the respective muscles. Figures G and I represent stretches that can be performed for approximately 45-60 seconds. Please refrain from doing exercises if pain is elicited.

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Figure D. Foam roll gluteals

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Figure E. Foam roll TFL

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Figure F. Foam roll low back. Be sure to keep back neutral or slightly flexed in order to avoid excessive stress on the low back.

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Figure G. Piriformis stertch

foam roll QL

Figure H. Foam roll quadrates lumborum (side of back).

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Figure I. Quadratus lumborum stretch (stretch to side of back)

Last step is to stabilize the spine by avoiding an anterior or posterior pelvic tilt. I recommend stabilization of the lumbar spine with the back in neutral.

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Figure J. The picture to the left represents an anterior pelvic tilt. The picture in the middle represents a neutral spine. The picture to the right represents a posterior pelvic tilt.

In this blog I have purposely avoided educating on abdominal stabilization as I believe that the exercise for stabilization should be monitored. The reason individuals have pain in the first place is because of a movement dysfunction, so I highly suggest getting assistance from a trained movement specialist (physical therapist, personal trainer, athletic trainer, pilates instructor, yoga instructor etc.). Pain does not just appear but is comes about due to increased stress being placed on a structure in the body over time. REPAIR THE MOVEMENT AND YOU IMPROVE THE PAIN.

Please take note that in order to have somewhat of a full recovery from this injury you must make sure that you are able to contract the deep abdominals appropriately and work on maintaining the contraction over time with your respective exercise/activity. With practice over time these muscles should contract involuntarily.

Over time if symptoms appear to be unrelenting and worsening we suggest getting further diagnostic testing to determine if there is structural damage such as a disc bulge/ herniation, degenerative changes in the spine, etc. Further medical treatment may be required in order to decrease symptoms prior to initiating an exercise program.

In our clinic we see many of these cases and have been very successful with treatment. We shall be delighted if you call us and schedule an appointment today. I am sure that you want to resolve the nagging pain in your ‘butt’.

You can Contact us at: Phone:703-858-5070, Email: office@missinglinkpt.com, website:www.missinglinkpt.com.

We are located at: 44933 George Washington Blvd Suite 165, Ashburn VA 20147

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Overcoming the Challenge of Today’s Healthcare System

As a young Physical Therapist growing in experience and knowledge I question our effectiveness in the healthcare setting. I don’t mean to generalize everyone, but I think we have lost the love for people. We have lost the sympathy and empathy on which healthcare was built on. Because of financial restraints we have cut the time spent with patients. Along with the time lost we have lost the ability to perform personalized care. I am not an exception and have been guilty of this; and with the loss of personalized treatment I believe that outcomes are not optimized. Being a healthcare professional does not only mean giving the right drug or correct treatment. By building an intimate relationship with your patient, a relationship of trust can actually enhance the affect of the drug or treatment provided. Yes, there is no research to show this, but through my clinical experience I have seen first hand that a combination of the right treatment and good relationship have positive outcomes. Conversely, the right treatment with flawed patient interaction showed poor clinical outcomes.

I don’t believe that we are going to heal everyone, but I do believe that we can optimize the quality of life and function of individuals with more TIME. I believe that with more individual time we can change peoples lives and we can ‘LOVE’ them more. We can be better at achieving the functional goals of the patient instead of priortitizing our own clinical goals with the time we have. I believe that with more time there will be less money spent overall and better utilization of our patients’ healthcare dollars.

In my young Physical Therapy practice there is a common trend of people coming to therapy only once a week. This is because with a one hour treatment focused on individualized care we are able to achieve the goals of the patient in a timely manner. People are, over time, paying less and also spending less time away from their overall ‘dysfuntion’. Individuals are optimizing their function and becoming an active part of society.

Our chronic population needs more individualized time as we are not only dealing with the physical affects of pain, but also the psychosocial aspects. We need to continue to challenge insurance companies on reimbursement for our respective skill sets. We are worth more!! We need to get back to patient centered healthcare where outcomes, quality of life and function are our primary goal. This is my utopia because I see it is possible with what I do on a daily basis. Patients and clients will testify to my ‘crazy talk!!’ The missing link to healthcare is not necessarily the next super drug, surgical technique or diet but rather the intangibles that cost us nothing. It is the eye contact, smile, attention, hug, holding of a hand… the list goes on! I challenge all those who are in healthcare to try this and see what your outcomes are. See the reaction that is driven from it.

Let’s love each other and the healing will follow.

Welcome to the Missing Link!!!

What is Missing Link Physical Therapy (MLPT)?? (MLPT) is a fee for service Physical Therapy Clinic focused on improving the function of patients in a timely fashion. We provide Physical Therapy services on a one on one basis in a private treatment room setting. The time you spend at MLPT is all yours. We also provide massage and personal training services (with specialty in restoring movement and decreasing injury for those in the performing arts).

This is the place where ‘Mind, Body and Soul Connect,’ MLPT focuses not only on the individuals mechanical deficits but we also focus of the emotional and psychosocial reasons for an individuals pain as this can contribute to chronic pain. So how do we accomplish the ‘Mind’ and ‘Soul’ aspects of care? Well first we love on you!!! This is important because by caring and providing a loving environment we are able to calm that nervous system down thereby decreasing pain and also the anxiety driven by pain. We also collaborate with other health care professionals when we feel their services will be complimentary to ours such as Clinical Social Worker’s, Personal Trainers, Orthopedic surgeons and the list goes on.

We have created this blog to inform the community about their health care options and to let individuals understand that they don’t have to live in pain. During the course of a series of  blogs we will address common acute/chronic injuries we see and have been successful in treating. We will also share our philosophical views on healthcare and ways we can improve outcomes and not over utilize resources.

We hope you continue to follow us on the path of healthy living and a healthy lifestyle. COME JOIN US AND HEAL WITH US!!

www.missinglinkpt.com