- Okay, we're gonna talk about a real story.
This patient's name is Fred, 70 year old
having low back pain for a number of months.
Went to a doctor, this doctor sent him to a surgeon.
The surgeon assessed the situation
and recommended a surgery to implant a E-stim unit.
In other words, a stimulation unit
designed to block the pain.
So what happened?
The surgery did continue and the implant was put in
the results negative, it did not work.
Actually, the E-stim wires broke
and now there's a second surgery planned.
- So the question is, could Fred have avoided back surgery
if he would've tried physical therapy first?
- My point exactly.
Now, after discussion with Fred,
my question was did you have any physical therapy
prior to the surgery to see if it could be avoided?
The answer was no, to my dismay, of course.
- So, if Fred had decided to go into physical therapy first,
here's what a physical therapist would've checked for.
- That's right, let's take a look at the spine.
We're looking at probably two common causes
of back pain in this age group.
Now, it could be something else,
but again this is typically what can happen.
The first thing is possibly a disc problem
and the second thing could be a stenosis.
Now, when you get at this age
stenosis does become more prevalent.
But first, let's rule out the disc problem.
This is also good education for the patient
so they understand what's going on in their body.
When you understand it, you feel more comfortable,
and chances of success, avoiding surgery go way up.
Okay, now the big thing that comes up in people's mind
is I've got a herniated disc, got a bulging disc,
we've gotta get it done, taken care of
surgically, excuse me.
Let's look at this, here we have this red disc here
representing a herniated or bulging disc right here.
Now that would be the situation.
Now let's talk about bulging discs in this age group.
Okay, let's look at the disc
and what happens with a disc as we age,
particularly 60 and above.
Here we have L4, L5, they are vertebrae.
This is just a model, a representation.
Now this red ball represents a disc.
When you are young, the disc is pliable and flexible.
It allows you to bend, twist
and absorb shock through the body.
Now, when a disc starts to rupture or herniate,
what happens is this.
Now remember the spinal cord goes through here,
this is the back of the vertebrae.
So this is a really dramatic representation
when a disc bulges, boom, it bulges like that, that hurts.
That can actually pinch a nerve causing pain in the back
all the way down to the toes.
Now, there's one big thing
that is really common with elderly people,
is the disc, the inner fluid that you see
allowing this to happen, becomes thicker.
It's actually, they describe it like crab meat.
So if you are at that age, particularly older,
the chances of having a herniated disc
actually drop significantly.
So sometimes the MRIs show a bulging or herniated disc
and it may have been there for a long time
and it's not the source of the problem.
The whole point is ask the doctor,
ask the surgeon to really look at this closely.
And sometimes it's nice to get a second opinion.
All right, the second scenario is stenosis.
We got lumbar stenosis in the low back
where the nerves actually get pinched
because the hole, they call it the foramen actually shrinks.
And there's a number of reasons that can happen.
Now, if the person presents with pain
where they are standing or they walk and pain gets worse
and then when they sit down very quickly, the pain subsides.
It's a very strong case that it could be stenosis.
Now there's some more things
that the therapist will do to determine that,
and we're gonna show you some exercises that can also help,
which we've had good success with eliminating.
So let's go forward and look at those options.
All right, now, if Fred would've came in
and he presented with one-sided back pain
and he cleared all the red flags,
in other words, I thought therapy may be a good option.
This is one exercise that we would try.
It's called, well, I call it the doorframe stretch.
So Mike, go ahead.
And the idea is if the pain is on the right side,
he's gonna actually reach up with his right hand
and stretch, go ahead, Mike, can you explain it?
- So you're gonna reach up, touch the top of the doorframe
and then I'm going to lean into the side,
leaning to my right, notice how my feet are staying in place
and I'm getting a good stretch in here,
opening up and spreading that spine apart,
getting relief off of those nerves.
- Right, so makes let's it clear
you don't have to use a doorframe.
And if you have door that has, is not solid,
don't use it, it won't be safe.
You know, you can use something if you have a pull-up bar
or something of that nature
where you can safely suspend your weight.
Okay, with these exercises, like Mike just demonstrated,
what we're going to continue to show is
it needs to feel good while you're doing the exercise
making that pain better as well as afterwards,
not just right away, but over the next 24 hours.
Then continue as long as positive results, Mike.
- So a big red flag is if you're having weakness in your leg
that is also coming from your back pain.
You're gonna wanna go see the doctor
and get this checked out further.
And if they determine physical therapy is appropriate
then give these a try.
- All right, let's go on to the next exercise.
This is another version
if you do not have that door frame to hold onto
simply take a stick,
it needs to be something pretty stout, okay?
So it is not too flexible or won't break.
Now, Mike is showing it here.
He's stretching the right side out, go ahead Mike.
- So I grab up as high as you can on this pole.
I'm gonna have my hand and palm facing away from me.
I'm going to have a pulling force going down,
like I would on the doorframe,
and then I'm gonna start leaning the stick
away from me like this.
Getting that nice traction feeling.
If this feels good while you're doing it and after,
then this is a stretch you wanna continue doing.
- Just one warning.
If your stick does not stick well to the surface, the chair,
or table, because it doesn't have a rubber grippy thing
like the Booyah Stik, simply put a shoe down,
put it in there, and it really does the job.
Okay, another complete option for an exercise
is extension in lying, or prone press-ups.
You're gonna lie down on your stomach,
preferably on a firm like a carpeted floor.
Mike's gonna demonstrate here.
You imagine that your buttock or your belt line
is glued to the floor or the bed
and you simply do a press up,
notice how it arches the back.
You will only do this one if it feels good.
Now, the first couple repetitions, if it hurts
but it gets better, clearly gets better by the third one,
then you can continue.
Now, if it gets worse after the third one
and continues to feel like it's not helping,
you stop, it's not for you.
This one typically works with a disc problem.
All right, and this in regards to repetitions,
you're not gonna do more than 10 at a time.
Again, it should feel good or actually make it feel better
while you're doing it, as well as afterwards.
For example, when you get up and walk around,
we do have another video that goes into this more detail.
If things are going well with it,
you can look at that, I encourage you to.
Okay, now these exercises so far have not been helping,
this is a good option.
This actually works particularly well
with most people with stenosis.
We're flexing the spine and Mike's gonna demonstrate
some very simple exercises that will give quick relief
if they're the right ones.
- So to perform this exercise,
you're going to need to lie on the bed or the floor.
You're gonna bring one knee up towards your chest like this,
keeping the other leg down, and get a nice good stretch.
Now, after you hold this for 15 to 30 seconds,
perform it on the other leg.
See if one side is tighter,
or if this is helping your back pain.
If this is feeling okay, you can progress
to bringing both knees up to your chest
and just sitting here for a nice 30 seconds and relaxing.
The spinal flexion can help relieve that pinching sensation
on those nerves that you are experiencing.
- Good job, Mike.
This would be repeated two to three times per day
as long as relief is experienced.
Now looking at this from Fred's point of view
in regards to therapy,
now this is what a therapist typically would do.
They'd assess all these different options
and both Bob and I have experienced good success
with having the back pain relieved.
It's just worth it to seek physical therapy
versus a surgery, at least one or two visits.
- So if you wanna try physical therapy
and your doctor didn't prescribe it,
simply call them and ask.
Most of the times, they'll give you the option.
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