This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2023. For the original video go to https://www.youtube.com/watch?v=rRVZIj5RDU0&t=384s
Brad: Okay, we're going to talk about a real story. This patient's name is Fred, a 70-year-old, who had low back pain for several months. He went to a doctor and this doctor sent him to a surgeon. The surgeon assessed the situation and recommended surgery to implant an 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 were negative, it did not work. The E-stim wires broke, and now there's a second surgery planned.
Mike: So the question is, could Fred have avoided back surgery if he had tried physical therapy first?
Brad: My point exactly. Now, after a discussion with Fred, my question was did you have any physical therapy before the surgery to see if it could be avoided? The answer was no to my dismay, of course.
Mike: So if Fred had decided to go into physical therapy first, here's what a physical therapist would've checked for.
Brad: 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 to 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 minds is I've got a herniated disc or a bulging disc. We've got to get it done, and taken care of surgically. Let's look at this. Here we have this red disc, representing a herniated or bulging disc.
Brad: 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 the back of the vertebra, so this is a really dramatic representation.
Brad: When a disc bulges boom, it hurts. That can pinch a nerve, causing pain in the back and all the way down to the toes. Now, there's one big thing that is common with elderly people, the disc, the inner fluid that you see, allowing this to happen becomes thicker. They describe it as crab meat. So if you are at that age, particularly older, the chances of having a herniated disc drop significantly. Sometimes the MRIs show a bulging, a 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 to ask the doctor, ask the surgeon to look at this closely, and sometimes it's nice to get a second opinion. All right, the second scenario is stenosis. We've got lumbar stenosis in the lower back where the nerves get pinched because the hole, they call it the foramen, actually shrinks. There are several reasons that can happen. Now, if the person presents with pain where they are standing, or they walk and the 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 are some more things that other therapists will do to determine that, and we're going to 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 come 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. I call it the doorframe stretch. So Mike, go ahead. And the idea is if the pain is on the right side, he's going to reach up with his right hand and stretch. Go ahead, Mike, can you explain it?
Mike: So you're going to reach up, touch the top of the doorframe, and then I'm going to lean 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.
Brad: Right? So let's make it clear, you don't have to use a doorframe. And if you have a doorframe that is not solid, don't use it, it won't be safe. You can use something if you have a pull-up bar or something of that nature, where you can safely suspend your weight. With these exercises like Mike just demonstrated, and 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 afterward, not just right away, but over the next 24 hours. Then continue as long as you get 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 going to want to go see the doctor and get this checked out further. And if they determine physical therapy is appropriate, then give these a try.
Brad: All right, let's go on to the next exercise. This is another version, if you do not have that doorframe to hold onto, simply take a stick, it needs to be something pretty stout so that it's not too flexible or won't break. Mike is showing it here with the Booyah Stik. He's stretching the right side out. Go ahead, Mike.
Mike: So grab up as high as you can on this pole. I'm going to have my hand and palm facing away from me. I'm going to have a pulling force going down like I would in the doorframe, and then I'm going to start leaning the stick away from me. Getting that nice traction feeling. If this feels good while you're doing it and after, then this is a stretch you want to continue doing.
Brad: Just one warning, if your stick does not stick well to the surface, a 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 going to lie down on your stomach, preferably on a firm surface, like a carpeted floor. Mike's going to 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 of repetitions, if it hurts, but it 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.
Brad: This one typically works with a disc problem. All right, and in regards to repetitions, you're not going to do more than 10 at a time. Again, it should feel good, or make it feel better while you're doing it, as well as afterward. For example, when you get up and walk around, we do have another video that goes into this in more detail. If things are going well with it, you can look at that. I encourage you to. Okay, now if these exercises so far have not been helping, this is a good option. This works particularly well with most people with stenosis. We're flexing the spine, and Mike's going to demonstrate some very simple exercises that will give quick relief if they're the right ones.
Mike: So, to perform this exercise, you're going to need to lie on the bed or the floor. You're going to 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.
Mike: 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.
Brad: 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, 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 this back pain relieved. It's just worth it to seek physical therapy, versus surgery at least one or two visits.
Mike: So if you want to try physical therapy and your doctor didn't prescribe it, simply call them and ask. Most of the time, they'll give you the option.
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