Tag Archives: hip pain

12 Quick Fixes for Back Pain

I know how miserable back pain can be. But, I also know from years of personal experience managing injury, inflammation, misalignment and aching for myself and others that spinal health is largely about the little things that add up. Simple exercises, ways we approach our day, and healthy habits can make a big difference. Whether you have back issues on a regular basis or just some discomfort during less active winter months full of movie watching and holiday travels, these quick fixes for pain can work for you! A happy back = A happy body.

untitled-design-3Foam Roll

Foam rolling is the equivalent of taking a giant-sized rolling pin to your body and working it out like a ball of cookie dough. Rolling out the kinks in myofascial tissue will help you feel better than gobbling up a handful of those warm cookies. I’m totally serious, people! 

You see, our muscles are all surrounded by fascia which is strong, thin, connective tissue that responds best to pressure in order to release tension and knots (whereas muscles respond best to stretching). If part of our fascia is too tight because of one of two extremes; improper recovery from hard exercise or not exercising enough, then the muscles underneath will not be able to move as effectively as they should. Dehydration can also cause this tissue to become rigid and stick too tightly to underlying muscles. You might not immediately feel the negative repercussions, but over time tight fascial tissue can result in your hips getting out of alignment, IT-band syndrome, low back pain, and more.

The key is to use a foam roller much like a rolling bin when baking. Start with long rolls, using your body against gravity on the foam roller, and then find the areas that need a little more attention. It might hurt a lot at first if you’re really tight (just being honest), but that will subside the more you do it. Plus, the tighter you feel, the more your body is telling you that it NEEDS this! Onward you roll! 

Apply Hot or Cold

Using heat or cold-pack treatments is a classic and super easy way to deal with nagging discomfort. The key is to know when to use each temperature. There is some debate about this in the medical community at large, depending on what culture and philosophy your doctor comes from, so take my advice with a grain of salt if you want.

I generally advise clients to use heat for aches that are chronic and cold for acute injuries. For example, if you have an aching low back that gets worse over the course of a few weeks but you can’t pinpoint the exact cause of the pain, then I suggest using a heat pack on it overnight or while you’re lying down for a period of time. If you have a sudden onset of pain like waking up in the morning with a piercing pain radiating from your neck to your temples or a shooting pain in your shoulder after lifting something, then I suggest you use ice. In both scenarios, it’s a good idea to talk to your doctor if you’re concerned and the pain seems to linger or worsen.

Turn to the “McKenzie Method”

If you have low back pain that is chronic or acute (especially if you have sciatic pain), then finding a good physical therapist who can evaluate you via the McKenzie Method for low back pain is a great idea. The initial evaluation and first visits may not feel quick per say, but you will gain all sorts of fast, easy-to-perform-at-home exercises that will save you time and discomfort down the line.

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Stretch Hip Flexors and Hamstrings

Stretching these two muscle groups is one simple and effective way to rid yourself of tightness in your back. These muscles pull on the hips and spine and can thrown things out of whack when they are too tight. Both the hamstrings and hip flexors can get tight from sitting for long periods of time or exercising without enough follow-up stretching. Effective stretching can be done in less than five minutes. Hold each hamstring in a stretch for a full minute or slightly longer for maximal benefit (less than a solid minute of stretching may not help). Do the same thing for each hip flexor and you’re on your way to feeling sweet relief.

Correct Sitting, Lying and Standing Posture

The entire spine gets misshaped when we sit, lie and stand hunched over with our shoulders. The human spine’s curvature has specifically adapted to work with gravity, so when we take it out of its optimal position, it can no longer properly do its job. Also, when we are constantly tucked into a ball while sleeping or leaning forward at our desks, our musclces begin to develop a memory for being stretched out in the back and tight in the front. This will lead to all sorts of discomfort and issues down the line, plus it depletes from a tall, attractive posture (and by tall I mean upright – not necessarily sky-high height).

Correcting posture can actually feel uncomfortable, just like getting started with foam rolling. But, the more uncomfortable we are when standing with our shoulders back and heads held high, the more of a red flag our bodies are waving in front of us. Our bodies are screaming at us to get things back in order. It may be uncomfortable but it’s way easier than dealing with the fallout of bad posture over time. All it takes is reminding yourself to do it. Not too complicated, right?

Sleep with a Pillow Between Legs or Arms

Sleeping with a pillow between your legs or hugging it like a giant teddy bear in your arms can help “stack” your joints so they maintain better neutral alignment over the night. When you think about it, we are in bed for a long time every day. If we get 7-9 hours of sleep every night and are tucked into a ball, have one leg thrown over the other, or all our body weight on one shoulder the whole time, we are bound to eventually feel a little “off.” Sleeping on your side with a pillow between your legs can help alleviate some types of hip and low back pain. Sleeping on your side with a pillow between your arms can help some types of thoracic and shoulder pain. Plus, it just feels snuggly. 🙂 

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Perform Chest Openers

Chest opening stretches or “heart-opening poses” in yoga are wonderful ways to make sure that the muscles of the chest stay stretched out and the ones in our backs stay tight enough. A lot of back pain comes from poor posture and all the movements we do like reaching forward which create tight muscles in the front of our bodies and loose ones in the back. Tight muscles are not the same as strong ones and loose muscles are not the same as flexible ones. So, it’s important to balance out our forward-reaching activities with a simple opening of the chest for 30-60 seconds a few times a day. A great time to do this is when you need to take a deep breath to think at work or when you are in the middle of chores at home. It can be as simple as standing in a door jam, holding onto the frame, and moving the rest of your body forward a couple steps. This can make for a nice deep release in the chest.

Exercise Large Back Muscles

Large back muscles can be targeted through lat pull downs, rows, pull-ups, reverse flies and rotator cuff exercises. Just spending a couple minutes on these muscles every gym visit can add up to a lot. That is, if you aren’t already working them out. It’s best to perform these exercises once your back is in alignment so make sure you’re using other techniques if you’re experiencing a lot of discomfort or pain.

Exercise Long Back Muscles

The long muscles in our backs can be targeted through all sorts of spinal extensions, typically best done lying face down on a mat and lifting our limbs, or from a standing position using exercise bands or cables. Again, a little can go a long way. It’s tough to remember that exercises like these are just as important as the ones that produce a mega sweat session, but they are. Just as important. If you’re feeling at a loss for how to get started on these, attend a beginner’s Pilates class and make notes of the exercises they do for the back. Try to repeat them at home or hit up the class again!

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Adjust Lifting and Carrying Form

Everything we do, from carrying little ones and groceries to lifting our luggage and briefcases, impacts our spinal health. When we repeat the same motions again and again on just one side of the body we risk throwing ourselves off in terms of both alignment and strength. Try to remember to switch baby from that favorite hip to the lesser-used one. Try to walk to work with your purse on the opposite shoulder sometimes. Simple things like that. It’s what makes or breaks us.

Use Lateral Movement

Lateral hip movement (and rotation, by the way) helps to stabilize the hips and take pressure off of the back. We do a lot of forward movement but not a lot of side-to-side, and it’s just as essential for our health. One of the best ways to tackle this type of movement is via clam shells and other lateral hip lifts which target the outside of your booty (aka the glut medius and glut minimus). All you have to do is put yourself in a side-lying position and lift the top leg up and down in various ways to elicit a burn in the outer compartment of your rear end. When you feel the burn, keep going! It’s good for you.

Reduce Inflammation

Inflammation sucks. It just makes everything miserable, including our backs. So, try to help your joints by eating a balanced diet with all the good stuff; leafy greens, berries, other fruits/veggies, whole grains, healthy fish, lean proteins, beans, nuts, you get the idea. People who are trying to heal from illness or injury will especially benefit in the healing process by eating as healthy as possible.

Also, drink plenty of water to keep joints lubricated and get a balance of exercise and adequate rest. The healthy basics really do a lot reduce inflammation.


Yours in health and wellness,

Maggie

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Two Sources of Pain for Women

At some point in life, lots of women experience pain in their stomach, back, hips and/or knees. The sources of these pain points may feel elusive, but in many scenarios, there are two culprits to blame. I’m here today to help you identify whether you, or a woman you care about, has one of these conditions.

Q Angle

 PAIN SOURCE #1: LARGER Q-ANGLE

Women have wider hips than men. This is not surprising information. In some women, a wider pelvis results in a steeper angle between two landmarks: the ASIS and the patella.

The ASIS stands for Anterior Superior Iliac Spine. Don’t be intimidated – this is easier to identify on your body than it is to pronounce. Place your hands on your hips, like you’re standing with a little sass (thumbs pointing back and fingers forward). Feel where your middle and ring finger fall on the front of your hips. Slide your fingers slightly inwards and you will feel a bony part of your pelvis if you push into your flesh. You found it!

Next, place two fingers on your kneecap. You found the patella! So much easier. 

The Q-Angle is an angle measured between these two landmarks. It’s best done by a physical therapist or qualified fitness professional using a goniometer. Yuck, so many dull scientific words.

For a great visual, check out the illustration on this website: http://bit.ly/1CWkk4X (scroll down just a little on the page)

Why is this relevant to you? 

If you’ve experienced knee pain or instability, ACL issues, pain with running or jumping, and/or hip pain, then you may have a “large” Q-Angle. This doesn’t mean there is anything wrong with you, so don’t panic! It simply means that your kneecap tends to be pulled at a harsh angle, causing stress on the surrounding soft-tissue structures.

Although it’s super unfair that nature has made women more prone to knee pain than men, there are simple ways to ensure knee health. Here are a few:

1) Strengthen your quadriceps. Your quads are the large muscles on the front side of your thighs. These muscles are above the knee and help stabilize your kneecap’s movement. You can strengthen these muscles through controlled leg extensions, leg presses, and squats.

Leg Extension

2) Foam roll your IT bands. Your IT-bands are dense, connective tissue on the outside/lateral aspect of your thigh. Tight IT-bands can add tension and stress to the knee.  Since there is already a strong pull on your kneecap based on a large Q-Angle, it’s important not to add any unnecessary tension to the knee.

A foam roller is a cylinder made of densely packed foam. You can roll your body back and forth on the roam roller to relieve tension in any area. It’s like you’re a big ball of dough on a rolling pin! Not what a woman wants to imagine herself as, I know, but the analogy works!

If foam rolling hurts a lot, it’s a sign your connective tissue is really tense and needs this release. You can reduce discomfort by placing one leg in front of the other, distributing your body weight into the assisting leg.

Note: It’s really important that you don’t roll directly over joints. Ouch. 

3) Control knee stability during lower body exercises. If you watch yourself in a mirror, or even look down at your knees, while performing a lower body exercise, you may notice that your knees drift slightly inwards. When your knees drift towards one another, it creates stress on the joint capsule. Although this may improve with leg strengthening exercises, it may also be a factor of form.

You can increase your awareness by simply being mindful of your form. If you notice that your knees are drifting inwards, simply exert a little effort and move them wider. It doesn’t have to be excessive. It should feel more comfortable and will help you feel better balanced.

4) Strengthen your “outer thighs.” This may surprise you, but there aren’t any “outer thigh” muscles per say. When you perform exercises to target this area, you’re actually working muscles in the outer region of your hips/gluts. More specifically, muscles called your gluteus medius and gluteus minimus. 

A wider Q-Angle means that these muscles are pulled and elongated a bit more than usual, resulting in them being less stable and strong. Since knee health depends a lot on ankle and hip stability, it’s a good idea to strengthen these oft-forgotten muscles. You can do this through side lunges, lateral movements, lying side leg lifts, clams, and more.

 

PAIN SOURCE #2: DIASTASIS RECTI

Even if your baby-making years are far ahead or behind you, this is relevant information because it may impact you some day, or it may have taken place during pregnancy without your awareness. For women who plan to have children soon, or who are currently pregnant, listen even closer.

Diastasis Recti

We’ve all admired another person’s six-pack at some time or another, right? Well, imagine that the rippled six pack has an enormous split down the middle, separating and pulling the two halves away from one another so that the abdomen looks a little more like two three packs. This is what Diastasis Recti looks like. For a great visual, click here: http://bit.ly/1JQoYaS

Why does this happen?

When a woman gains weight with pregnancy and extra pressure is placed on the abdomen as it stretches, the core muscles are under great strain. The six-pack muscle naturally stretches with a growing uterus, but in the case of Diastasis Recti, the connective tissue that coats your core (the linea alba) gets stretched to a greater degree. The split can sometimes appear as a ridge in the abdomen and can be felt by placing fingers into the crevice. Diastasis Recti is usually diagnosed when the space is two finger widths.

What are the consequences?

Diastasis Recti can compromise a woman’s overall core strength, leading to secondary conditions that challenge overall health and wellbeing. Some women also experience a post-pregnancy “pooch” that they just can’t seem to get rid of because it isn’t a factor of weight loss. Diastasis Recti may present with multiple other conditions such as:

  • Back pain and instability
  • Compromising posture
  • Pelvic floor dysfunctions Hernia
  • Pelvic pain and instability
  • Gas and Digestive problems
  • Fecal incontinence (Constipation)
  • Pelvic floor dysfunction (SPFD)
  • Urinary incontinence
  • Pelvic organ prolapsed

One of our readers shares her personal experience…

When Jenna knew something was wrong:

“Sometime in the middle of my third trimester (while pregnant with my first child), I realized that I had Diastasis Recti. I was only aware of the condition because of my background in nursing school. The particular activity that made me aware of my abdominal separation was trying to sit up in bed (the wrong way). As my stretched-out abs attempted to engage, I saw what looked like a mountain ridge down the middle of my abdomen. This was a little frightening to see and though I was not experiencing pain, I could tell something was not right. When I mentioned this event to my caregiver, I received no concern and no education was given regarding how to protect myself when bearing weight or how to properly exercise my core post pregnancy.

Roughly two years later, I gave birth to my second child and suffered three tears. Even after my injuries healed, my pelvic pain lingered. It was noticeable with long periods of standing at my kitchen counter or when taking long walks outside. The pain was especially acute when I would sit up from a reclined position in bed after nursing my newborn for night-time feedings. I made an appointment to discuss the pain with my provider. She recommended pelvic physical therapy for my ‘pubic symphysis dysfunction.'”

How Jenna got better:

“I am so thankful that I took this recommendation! My pelvic PT taught me about the anatomy of the female pelvis and how childbirth impacts and often compromises core strength. I learned how to measure my diastasis recti and what exercises I could practice to help approximate the abdominal muscles. I learned how to protect my core by creating a “pelvic brace” for exercising and weight lifting. I also learned the proper posture for carrying my baby, how to get in and out of bed, and safe body mechanics for lifting my car seat.

Over a five week period, my pain significantly improved and was rarely noticeable! Only after a two week period of not exercising did my pain return (minimally). I discovered the reason for this is because I’m still breastfeeding my baby and this allows the relaxin hormone to linger, thereby creating instability at the pubic symphysis and also making it difficult to build muscle. While breastfeeding, maintaining my core stability means that I have to exercise regularly (4-5 times a week) and practice Kegel exercises daily. If I can commit to these practices, I remain pain free!”

Thank you, Jenna, a million times over for sharing this personal journey!!! It takes a lot of courage to share it and no doubt other women will benefit from hearing it. 

How do I exercise to prevent or correct Diastasis Recti?

If you believe that you have diastasis recti, then I suggest you work with a reputable physical therapist for at least a few sessions, to get on the right track. As mentioned in the former testimonial, it’s important to learn proper biomechanics for sitting up in bed, lifting heavy objects, and bracing your core during exercises. A great place to start is by checking these exercises, performed by my lovely former colleague, Alison, and presented by my wonderful friend and former PT Cari: http://www.releasept.com/videos/low-back-core/ (The first nine videos work on core bracing in a gentle, but effective, way.)

Jenna’s PT, Stephanie Fournier, has also been extremely generous with her time, and has offered us some answers to important questions about this condition. See her interview below.

 

INTERVIEW WITH WOMEN’S HEALTH CLINICAL SPECIALIST

Maternal Health

1) How many women do you encounter postpartum who have severe pelvic and core instability, and/or a diagnosable condition?

First, I would define severe pelvic and core instability as any pain or dysfunction in the postpartum period that is affecting activities of daily living. This could include severe pain, restriction in activities, avoidance of activities, or slowing a woman down in her normal activities. That being said, the exact number is hard to quantify since I treat in an outpatient clinic where I am only going to encounter those women who do have problems (core instability and/or pain) and who are coming to me via doctor or self-referral. However, I do believe that pain and dysfunction in the postpartum period go largely under diagnosed. What I hear most often from patients is that they tried to talk to a friend, family member, or healthcare provider about their pain/instability/limitation and they are told things such as, “That is normal, you just had a baby,”… “It will get better after the pregnancy,”… “You just have to live with it.”

Some research numbers to reflect on:

  • Incidence of lower back pain and pelvic girdle pain (PGP) in pregnancy range from 68.5% to 76% in prospective studies (Wang, 2004; Kristiansson, 1996; Ostgaard, 1991). And the incidence of PGP alone in pregnancy was 20%, in one prospective ,study (Vleeming, 2008). Why the discrepancy? Most likely pain is under reported.
  • 70% of women experience some sort of lower back or pelvic pain during pregnancy.
  • 1/3 of women report severe limitations in activities of daily living as a result of back and pelvic pain (Ostgaard, 1991). The risk for back pain increases postpartum (Ostgaard, 1997).
  • Most importantly, women having back and pelvic pain are 3x as likely to have postpartum depressive symptoms than those without pain (Gutke, 2007).

2) How do most women identify that they have Diastasis Recti? What tips do you have for identifying it as early as possible?

Most women that I see in the clinic do not realize that they have a diastasis recti (DrA). Often, they are coming to me for pelvic pain (posterior pelvic girdle pain, pubic symphysis dysfunction, lateral hip pain, or abdominal pain) and it is something that we find during our evaluation. They might have noticed a tent or pooch in their abdominal area with sits ups, supine to sit (getting in and out of bed) but didn’t exactly know what it meant. For identifying early on, women can measure themselves with their fingers or a tape measure or just look at their tummy when they are rolling in bed or sitting up in bed.

To measure; the patient starts in supine with their knees flexed. They can place their fingers horizontally in the umbilicus and raise their head up. They are measuring how many fingers they can place inside the gap in the rectus abdominis. [It should be noted that this finger method is highly unreliable and it is better to use a tape measure, however the tape measure is hard to do on yourself]

Some more research numbers to be aware of:

  • 66% of women develop a DrA by their 3rd trimester.
  • 39% of women have a significant DrA several years after delivery. Significant is defined as separation of 2.5cm or more (Ranney, 1990).
  • More than 50% of women presenting for urogynecological examination presented with a DrA. These are postmenopausal women. Likely, the DrA developed during the child bearing years and never fully resolved postpartum, leading to poor core stability and pelvic organ prolapse (Spitznagle, 2007) .
  • DrA is associated with varying degrees of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse (Spitznagle, 2007). This is why treating DrA early on in the postpartum period is so important to me. We could potentially be helping women to avoid major symptoms and even surgery.

Also, Parker (2008) found that women with DrA tend to have higher degrees of pelvic or abdominal pain.

3) How soon after pregnancy can women start working their core muscles again? How do you suggest they start?

I recommend that women return to activity postpartum as they feel comfortable. However, I do have a few recommendations for those women who do have a DrA [separation of 2.5cm or more at the umbilicus, 4.5cm superior to the umbilicus, and 4.5cm inferior to the umbilicus].

  • Avoid obliques, regular crunches/situps, and planks until the DrA is reduced to 2.5cm or less OR the woman can affectively activate a co contraction (transverse abdominis + pelvic floor muscle contraction)
  • When treating a DrA, I start with initiation of TrA (transverse abdominis) which they can start day one postpartum with or without a c-section
  • Progress to DrA curlup (Neville, 2008)
  • Various TrA stabilization activities or progressions, depending on the individual
  • Consider corset or elastic binder per the individual
  • Avoid bearing down (valsalva) and sitting straight up (in bed/jack-knife)
  • As always, ensure proper pelvic floor muscle activation (including power, endurance, and coordination)

Thank you, Stephanie, for sharing your wisdom and expertise! You went above and beyond!

If you have any questions about this content and/or exercises to improve your health, then please don’t hesitate to reach out! Upon request, I’m happy to share the medical studies that Stephanie referenced too.

Being a woman can be tough stuff, but there’s no reason why we can’t feel amazing and pain free!

Yours in health and wellness,

Maggie

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References:

https://www.abdominalconnections.com/diastasis-recti/

http://gregnuckols.com/2013/07/17/do-women-need-to-train-any-differently/

http://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti