October 2011
The prevalence of significant weight gain, leading to obesity, has been on the rise in the United States for the past several years at an alarming rate. In 2010, 25.5% of Washington State’s population was considered obese with a body mass index (BMI) greater than or equal to 30, according to the Centers for Disease Control. As these statistics continue to rise so does the occurrence of low back pain. Low back pain is the fifth highest reason for physician visits and effects 80% of the population at some point in their lives.
Injuries and conditions that affect the spine include osteoarthritis, disc herniation, nerve root compression/irritation, ligamentous and muscular injuries. These injuries occur more frequently when the biomechanics of our spine function incorrectly. As a result of weight gain, the biomechanics of our spine change and stress is placed on tissues that are not designed to carry weight or move a certain way. This may lead to the tissue failing under the abnormal load and cause pain and pathology (Vismara 2010).
People with higher BMIs, frequently are found to stand with an increased pelvic tilt, have more rounded curvature and stiffness in their thoracic spine and forward head posturing. Movement patterns are also altered in patients with obesity. Sequencing of muscle contraction in their hips and back muscles can be abnormal enough to cause injury to the spine and thus cause low back pain.
Physical Therapy can reduce LBP!
· Restore normal joint mechanics and muscle control through hands on techniques and exercise
· Reduce pain with massage, mobilization, exercise and modalities
· Develop a healthy exercise program for weight loss and muscle training for people of all shapes and sizes
What you can do
Start with a healthy BMI for you:
Normal: 18.5-25
Overweight: 25-30
Obese: greater than 30
BMI = weight (Kg)/ (height (meters))2
World Health Organization
GET ACTIVE THE RIGTH WAY FOR YOU!
Lighten Up your exercise!
1. Reduce High Impact Activity
This will protect your joints from forceful loading
Low Impact High Impact
- swim - running
- speed-walk - jump rope
- water aerobics - Fast Dance
- weight training
2. Interval Training & Recovery Time
Perform a timed burst of cardiovascular exercise
followed by a cool down/recovery period.
Consult with your physician or PT before beginning significant cardiovascular training or fitness program.
The Achilles tendon (also known as the triceps surae), is formed by the confluence of the medial gastrocnemius, lateral gastrocnemius, and soleus muscles. Since it absorbs a tremendous amount of stress and is poorly vascularized it is a common area of injury.
-Acute Achilles Tendonitis -
This condition is an acute onset of pain in the Achilles tendon. The tendon, may feel swollen, red and painful at rest or when stretched. It can even feel squeaky when you point and flex your foot! Can be caused by poor foot mechanics, footwear, rapid increase in mileage, or even knee, hip and low-back contributions.
Good News—often if treated promptly, a quick healing time is seen.
If left untreated can develop into Achilles Tendonosis which is much more difficult to treat. An acute tendonitis can develop into a tendinosis as time passes.
- Achilles Tendinosis—
In normal healing, an injured Achilles tendon will go through inflammation followed by remodeling of the individual fibers within the tendon to build a new and strong tendon. A specific amount of load (exercise) is necessary to help rebuild the tendon and get it to the point where it can withstand the stress and loads of running again.
A tendon that has failed to remodel and is no longer in the inflammatory phase of healing is no longer an “itis” but an “osis” . The blood supply which carries the vital nutrients for repair is very limited in the Achilles region normally, especially with an Achilles tendinosis. If we could see the tendon it would look very dry, brittle and often frayed around the site of injury.
There is much debate in current literature and research whether these injuries are mediated neurologically or even sympathetically through the spinal nerves. This is why the spine is a key component when developing a treatment program for Achilles tendinosis. Surgery, dry-needling, and injections have all been utilized to try to stimulate an inflammatory response within the tendon to revert it back to a healing stage.
Physical Therapy can provide a functional and segmental assessment of the body to find biomechanical and neurological contributions that may be leading to Achilles pain and perpetuating the injury. A gait assessment, custom orthotics and footwear evaluation may also be key to fixing the kinetic chain.
Eccentric exercise is one of the most effective ways to strengthen the Achilles tendon. An Example (Left Achilles tendon pain):
Exercise: Perform a heel raise with both feet, and slowly lower yourself with only
one foot at a time.