Entries by dmiddaugh

How To Pick The Right Pillow For Neck & Shoulder Pain

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Hey there, welcome to The Stay Healthy El Paso Podcast, I'm your host, Dr. David Middaugh, I'm a specialist physical therapist over at El Paso Manual Physical Therapy. And we're going to be answering the question today about how to choose the best pillow for a neck and shoulder pain problem.

We have so many clients here in the clinic that are wondering, they ask us all the time, what's the best pillow for me to have, should I get a polyester filled pillow, or feather pillow that I found this pillow online that cost $300 I found this other pillow at the store that cost 20 bucks. And we have all kinds of mixed answers and results.

The fact of the matter is, it's very confusing, there are so many options. And depending on what kind of neck and shoulder problem each individual has, you want to approach it differently. And it's more than just the pill of a pillow. It really is a tiny factor. But it is a factor and it can make a difference. So we want to talk about it in this podcast for you today.

Let’s break this down. The number one question you got to start with is what is your preferred sleeping position? Are you more of a side sleeper? Do you sleep on your back? Or do you tend to sleep on your stomach?

Now whenever I asked that question, the first answer I get is a little bit of everything. Sometimes I start on my side, and I end up on my back. I started on my stomach and then end up on my side. Or I started on my back and then end up on my stomach. We get all kinds of mixed things. And what I’ll go with is, where do you start usually? Where do you start to fall asleep? How do you get most comfortable? That is what I would look to optimize for.

So, if you’re a back sleeper, if you start sleeping on your back, then you have to consider whenever you lie on your back, how rounded is your back, how soft is your mattress, and how far up from the bed is your head. In other words, if your back is kind of flat, you have a flatter back and you lie down and your head’s kind of comfortable on the bed, then you might even be able to get away with no pillow or a thin pillow. You might not need the thickest pillow ever.

But if you have a rounded back because you’re naturally are kind of there. There are some people that are naturally there, and you’d like to sleep on your back then you’re going to need a thicker pillow, because what you’re looking to do is fill that space between your head and the bed whenever you lie down.

That’s the critical key component here, because what you need to do is rest your spine, rest your neck and upper back without letting your neck hang backwards, or putting excessive pressure through your spine, your upper back area. Whenever you lie back, you’re looking to fill that space between your head and the bed whenever you’re on your back.

It’s a similar concept for when you’re on your side. If you go lie down your side, now there’s a space between where your shoulder hits the bed and your head, there’s going to be that gap between either your head and the bed and it’s taken up by that space between your shoulder and your neck. So, you’re looking to get a pillow if you’re a side sleeper that fills that gap that tends to be a thicker pillow than if you’re a back sleeper.

You just have to consider the sizes of it and the thickness of the pillow and also how much it gives because some pillows are real thick, but you put your head on and then you sink down quite a bit so it ends up kind of being thin whenever you actually lie down on it. You have to just feel them whenever you go purchase a pillow and see what’s best for you.

If you’re a stomach sleeper, then it can get a little confusing because if you’re the type of stomach sleeper that you put your arm across your face and your heads turn to the side, then you probably don’t need the thickest pillow or maybe you want a pillow to hug, because some sleepers tend to not sleep completely flat, they’re kind of at an angle. So you need a pillow under your chest or shoulder and you’re going to be turned off to the side so you don’t need the thickest pillow for that situation.

Now some stomach sleepers are really more of a side sleeper but are towards their stomach. So that’s a situation where you might need an even thicker pillow. So you have to consider how far away your head is from the bed in this situation.

The next thing you want to consider is the filling of the pillow. You want to generally avoid the lumpy materials. The lumpy materials are going to be polyester and feathers or down is the other term that you’ll see on pillow labels. The reason for avoiding the lumpiness is because if you’re having a neck and shoulder problem, chances are you’re going to be tossing and turning at night, probably subconsciously. You’re not going to be even awake while you’re doing it.

And if you got this lumpy pillow that you’ve been able to manage whenever you’re not hurting because you can kind of just shove the pole together and get the all the polyester all the feathers together in one spot and put your head on there and you sleep through the night for the most part or if you wake up, you can do it again. But now you’ve got this neck and shoulder problem.

You want to get good quality rest so you want the entire pillow to be about the same cushion You want to avoid having those lumpy materials like down and polyester feathers, because when you roll around those lumps will be in position when you first start to go into sleep, but whenever you’re starting to wake up and move around because your neck and shoulders are hurting you, then you’re probably going to roll off those lumps and you’re not going to get the best quality sleep you want to make sure that the amount of cushion is evenly distributed, and not just a lump in one area where you started the night.

The third factor here is considered having multiple pillows for different sleeping positions, because you might start out on your back and you might need a thinner pillow in that instance, and mid in the middle of the night you might turn on your side and in now you need a thicker pillow because the gap between the bed in your head while you’re on your side from your shoulder is bigger than when you lie on your back.

A thicker pillow that sustains its thickness is the best thing at that point. The general idea is you want your spine to be straight. So if you lie on your side, you don’t want your head hanging down towards the bed and your neck bending sideways. That’s not going to be very good on your neck, especially if it’s irritated in the shoulder as well. It’s going to put more pressure on the shoulder and it’s going to stretch out the tissues on the opposite shoulder that’s up from the bed.

It’s just not a good situation to have your head hanging downwards. So get a thicker pillow and a thinner pillow. Now we here at the clinic have custom pillows, we have a special pillow called pillow wise. And they come in six different sizes, they have different colored trim on them to indicate the sizes and they’re shaped differently on each end. On one end, they’re thinner, and on the other end, they’re thicker. And they are made out of memory foam so that they can evenly distribute the weight of your head or your soldiers, whatever you’re resting on here.

They’re designed so that when you lie on your back, you can lie down on the thinner end and it’s not pushing your head up so much and pushing your neck out of alignment. Or if you lie on your side, you can flip the pillow around and lie on the thicker end, so that it fills that gap between your shoulder and your, between the bed and your head where your shoulders pushing your head away from the bed more.

And depending on how broad your shoulders are, depending on your genetics, your exact sleeping position, because if you’re not directly on your side, then you’re kind of more leaning towards your back or leaning towards the front than you you’re going to want a thinner pillow because your head’s going to be closer to the bed.

Here in the clinic, these pillows that we have, there are six sizes, and we custom fit each patient to them, each patient that needs to get a pillow. Based on measurements, we actually measure their neck circumference we measure the distance from their head to their shoulder. And then we take other factors into consideration as far as how they sleep. We ask them a lot of these questions that I’m talking through with you right now so that we can best fit them to the pillow, and we found amazing results.

And I just want to give you the caveats here. The results are great and that the patients are getting better quality sleep. But we’re not solving a neck and shoulder problem. Pillows don’t solve neck and shoulder problems, they merely allow you to get better sleep, which is critical if you’re dealing with a neck and shoulder problem. Because the more you sleep, the better you can heal. And of course, the less grumpy you are and the overall healthier. You’ll be on other ends of your health, not just your neck and shoulder problem your immune systems I’m getting at.

If you get good quality sleep, you’re putting yourself in a better position overall to fix the neck and shoulder problem. But if you’ve got a rotator cuff tear and arthritis problem, a pinched nerve, or other issues that can affect the neck and shoulder, then this pillow type that we offer here, the pillows that I’m describing that you might go find at the store are not going to solve it. There’s usually some underlying root cause problem of muscle imbalance, some joints that are stuck, some other issues that need to be addressed so that your sleep can get better at night.

Think of it this way, if you fell, and hopefully this doesn’t ever happen to you. But if you fell really bad and skinned your knee on concrete or road or something like that, and you just had this massive road rash, let’s say you have like a six inch circle of road rash on your knee. It would hurt tremendously. Obviously, it would hurt even if you stayed still, if you were just lying down in bed at night, and you just had Road Rash earlier that day. Your knee would probably throb and hurt. And that’s just how it’s going to happen.

That doesn’t mean that you need a special pillow for it necessarily. It’s healing right now. So you just need to give it time and it will heal as it scabs over, as it goes through the healing process and eventually develop a scar and your skin is fine and your knees fine. Then it’s not going to bother you anymore. You don’t have to worry about it. But while it’s healing, it’s going to kind of bother you.

People that have rotator cuff tears, or arthritis problems in their neck or pinched nerves, it’s kind of like they have a fresh injury like that Road Rash example that I’m telling you about. And it’s just going to hurt and throb no matter what at night. So what you’re looking for is getting in the most comfortable position possible so that you can get sleep. But what you have to be doing simultaneously is figuring out how to solve that pinched nerve, arthritis, rotator cuff tear or other neck and shoulder problem during the day so that it’s not getting so irritated during the day so that at night, you’re able to rest better.

It matters more what you do during the day to solve your neck and shoulder problems so that your sleeping can become better and better over time. I just want to make sure that you’re approaching this correctly, because we get patients in here all the time that swear, they need a better pillow or even a mattress and they even go spend quite a bit of money on it. Which is fine if you needed a mattress or pillow.

Anyway, I’m not stopping you from doing it. I just want you to do it for the right reason, make sure that you’re looking to get it fixed. I want you to be in a situation where you don’t have to have surgery and having to rely on medications to go to sleep at night, or pain medications to get through the night. It’s not a healthy thing for you to be doing. You need to solve that that problem, the root of the problem, and it’s usually done while you’re awake.

So that being said, choose your pills wisely. Make sure that you understand that you’re just looking at getting that extra hour or two of quality sleep. You’re not looking to solve the whole neck problem or the whole shoulder problem.

Thanks for listening to our podcast, guys. If you're interested in what our pillows are like, they're not on our website, we don't sell them online. And we can't really, the maker doesn't even sell them online to the public. They have to be purchased through a medical office like a physical therapist’s office like ours. So, if you're looking up our pillows, they're called pillowise. So you can just go to pillowise.com or Google pillowise and you'll find our pillows and kind of how they work and they're pretty nice, they're there.

They're pretty high-end phenomenal pillows, we love them all our patients that have bought them love them. When patients buy multiples, often just because they want to you know want in their RV, when they're at their home, when at their guests room for their spouse. Oftentimes spouses come in and buy one because they get to try it out as well. And they really like it and they want their size pillow because they're all custom fitted for each individual's sleeping preferences in size their neck and shoulder size.

So anyways, you can call our office at 915-503-1314 to set up a time to come in and get fitted for a pillow if you if you wanted to do that. Our staff has special training on how to fit you for the pillow. And then also what I recommend is getting a discovery visit during which physical therapists can check your neck and shoulder problem out to make sure that you have all the information necessary to properly address your neck and shoulder problem.

We're not talking about certain treatment at this point, just knowing what's going on with your shoulder and neck problems so that you can have a better expectation of how this pillow can help you out and how to properly use the pillow what to expect with the pillow regarding your neck and shoulder problem.

Anyways, if you found this podcast was helpful for you, please give us five stars on whatever platform you're listening to this on. That helps us get this podcast out to people that potentially need our help people that want to get better in their health and just are trying to figure this out and learn how. So you'd be helping them out. I could care less about it for my ego for my sake. I want the people to get the help they need so please give us five-star reviews so that they can get help. We'll talk soon again. Have a great day.

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Natural Remedies To Start Healing A Rotator Cuff Tear

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Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David, specialist, physical therapist over at El Paso Manual Physical Therapy. And today we're going to be covering the top seven natural remedies for rotator cuff injuries. Now many people get rotator cuff injuries all the time. It's one of the most common shoulder injuries that we see here in the clinic. That I think plagues Americans unfortunately, and what a lot of people don't know that it is becoming more and more popular.

We even have scientific research to prove this. It's becoming more popular to not have surgery for rotator cuff problems and heal naturally we're discovering how to really do this. Well. Now here at our clinic, we feel like we have an excellent handle on helping people escape having a surgery, we have a track record, actually, for people that have been scheduled for rotator cuff surgery. And they call us as a second opinion. We get them in here and we honestly tell them hey, you know if you want to have your surgery, by all means go ahead. But I think that we can help you out.

We'll screen them out, and if we can't, we'll tell them. But if we tell them that we can help them, then we'll recommend that they start out with a few visits. And if it's getting better than they have an excellent shot at recovering naturally. And so far we've had 100% success rate where we get people that have had rotator cuff tears diagnosed by MRIs, and they're on a surgeon scheduled to go have it operated on, and then they end up postponing that appointment initially. While they start therapy with us and then canceling it because they get back to doing what they want to do and that shoulder stops bothering them.

We're really proud of that and so happy that our clients are avoiding surgery and really getting hugely confident. I don't mean they're just not in pain anymore. I mean, we get these clients lifting weights up overhead, returning to doing all the exercises in a very active things that they're doing.

One of the clients we finished recently loves to shoot. She's a handgun sharpshooter. And she's one of the best in the region actually, and just picking up her weapon to draw her weapon was killing her shoulder. She's also very active at home doing gardening, taking care of the house, she's a grandma has tons of grandkids and loves to bake and host them and be part of the family. And she was having trouble sleeping at night not being her usual self because of her shoulder issues.

She couldn’t pick up her arm up overhead at the beginning. And that woman did phenomenal shoes picking up 10 pounds over a head without pain just muscles getting tired. But that was part of a rehab in order to make sure that that rotator cuff tear is healed and isn't going to tear again. She's strengthening all the other tissues around it and safely strengthening the rotator cuff that was involved the part of the rotator cuff that was involved.

So, let’s get into the top seven remedies that you can try out at home or wherever you are so that you can begin the process of healing this rotator cuff.

Problem number one, you’ve got to get that inflammation under control by using ice and heat.

Now with ice and heat, you want to get something called an ice pack that you can purchase at the grocery store or even just get a bunch of ice cubes into a bag and put that on your shoulder and get back pain under control. And for some people, they don’t tolerate ice too well, it makes it hurt more. That’s cool, then it may just be that you’re more of a heat person then an ice person.

The research is unclear as to whether you should start out with ice or heat. I say just pick a place to start. Ice is usually the go-to for a lot of people. But if it’s not working out for you, then go to heat.

Now with both of these, when you try them out, put it put that ice or heat on for 15 to 20 minutes, get the ice to numb your skin. That’s how you know you’ve had it on long enough and take it off for 15 to 20 minutes. Then slap it back on and cycle like that three or four times.

If the ice is going to work for you, you should feel some numbness in the area and feel okay. Now if you go to pick up your arm, it’s still going to hurt because you still have the injury there. But at least it numbed the pain so that you might avoid taking that pain medication. Same with heat, it might feel like it just calms it down or after the goal of using ice and heat is to just calm the pain down so that you can sleep better so you can avoid taking pain medication and possibly even avoid visiting the doctor and just be a little happier for a little short period of time. And it’s a natural thing. It’s not taking pain medication.

But it’s not going to heal your rotator cuff problem though, it’s just going to bring down the inflammation to put you in a position to then begin to do things that are going to actually heal it. In some situations, people don’t respond to either heat or ice. If you find that you’re one of those people don’t be surprised or worried or shocked. That does happen. And it’s okay, there’s other things for you to try out.

Number two, this is a rarely implemented thing that I think has massive benefits is go get yourself a shoulder sling.

If you know what I’m talking about, it’s those things that you see that support your elbow and your forearm It’s usually just a piece of cloth that they might give you at a hospital or an urgent care place, if you hurt your shoulder arm. Just so that you can rest your arm in and it’s got a strap that goes behind your shoulder and around your neck on the opposite side and attaches to that same piece of cloth.

That kind of cradles your arm. Go get yourself one of those at a grocery stores, you can order them online there’s many places where you can find them and slap it on and tighten it up real good so that it shoves your elbow up. And the reason why you want to do that is because if you’ve got a rotator cuff injury, whether you suspect you have one or you know that you have one because you went and had an MRI or somebody checked you out and said that they really think that you got a rotator cuff injury.

Wear that sling, especially when you’re more busy, say you’re doing chores at home, or you’re out work or you’re out and about where people might bump into you or not know that you’re injured. And what it’s going to do is force you to not move so much that you don’t inadvertently use that rotator cuff muscle that’s got a tear in the tendon and potentially aggravated and it’s if you shove it up real high to make sure you tighten that strap down so that it shows it up. It brings the ball into the socket better so that it takes some of the tension and pressure off the rotator cuff.

You want to do that really for as long as it takes. I’ve had some people use it for a couple of weeks and get some immense relief from the pain. It doesn’t solve everything. It doesn’t make them all the way better where they can move their arm confidently and all that, but it brings that inflammation down and calms the rotator cuff injury down so they can begin to do some other stuff to help out that shoulder problem throughout the whole process of recovering it.

But that sling can make a huge difference. It’s super cheap, you can find one for probably definitely under $20 maybe even one first cheap as $10 and it’s well worth, it’ll cost you a bottle of pain medication, but it’s completely natural. And you don’t have to have it on 100% of the time. You can take it off obviously to shower and do things but when you’re more busy is the time to put it on.

Some people will sleep in them. It’s up to you when it comes to sleep get comfortable because you need to get quality sleep fine pillows to position yourself and whether or not you’re on your back or on your side. But you don’t necessarily have to put on this sling, but you might find that it works for you. Try it out and see what works best.

Tip number three easy rotation.

Let me explain this, it’s kind of an exercise, it’s kind of not, it’s just a very simple movement. Lie down on your back, you’ll get on a bed or a couch or even on the floor, and stick your arm out to the side, the involved arm. Let’s say it’s your right shoulder that’s hurting you and lift your elbow out to the side so that your shoulders at about 90 degrees from your body. Then bend your elbow about 90 degrees in really slowly and gently.

Let your hand move towards your head. You’re rotating through your shoulder and then let it go down towards your feet with your maintaining your shoulder joint at about 90 degrees outside from your body and just rotate to the available range of motion because you might get stuck or it might hurt to don’t push into pain are you going to do is real gently rotate back and forth like that, and do that for a minute or two. And how we do this frequently, I do this four or five, six times a day.

In some cases, especially if it’s real severe, I’d go to do this hourly. As you’re bringing that inflammation down, what you’re doing is you’re causing rotator cuff muscles to stabilize your joint during that motion. The ones that are not involved are typically to take over that motion, it shouldn’t be like otherwise, if you start to do it fast, or forcefully. Like when you rotate down this way or this way, down or up for your feet or your head. It can overactive your rotator cuff muscles and begin to aggravate that tear.

But if you do it real gently, it doesn’t hurt, do it slow, don’t force it into an enraged position, then you’re going to be able to use a rotator cuff muscles that need to work to compensate and offload the one that is injured.

Doing that exercise can make a huge difference to bring down that inflammation and get to where you’re not so painful and you are able to do some more advanced exercises as that rotator cuff tendon heals.

Number four, a shrugging exercise makes a world of a difference.

In addition to that rotation exercise, what you can do is just sitting down or standing up wherever you are, whether it’s at home, at work, in the car, just sit there and shrug your shoulders all the way up, just like so. Typically, this is really easy on the shoulder joint because you’re not moving the ball and socket, you’re just bringing those shoulder joints up towards your ears.

Just make sure with your neck, that you don’t put your chin up forward. Like a turtle. You want to maintain your chin down even a bit kind of like a double chin position, of a slight double chin position, as you shrug. That will activate the shrugging muscles, the ones that can connect your neck to your shoulders and begin to offload the rotator cuff tendon as well out in the shoulder joints.

You can do that just as frequently as that rotation exercise you might do an hourly and the way to do it, to hold that shrug for 10 seconds, and I’ll repeat that 10 times in a row. You can take little breaks, a few seconds here and there, it should be kind of tiring. Honestly, you might even start to break a sweat as simple as that exercise looks, it’s pretty challenging for people that have had that have shoulder problems. So don’t be surprised if that happens.

You might even get sore in those muscles. Just don’t do it so intensely or aggressively that your neck starts to hurt, or your shoulder starts to hurt, ease off on the intensity, and you might not hold for the full 10 seconds. Also, if you’re having that problem, you can hold for less but work your way up to 10 second holds as you get better at doing that shrug exercise.

Tip number five, pulley exercises.

I’ve got a pulley here. This is what I mean by this. This is a very commonly used physical therapy tool. And you can find these at pretty much any physical therapy offices. You can buy them off of Amazon, and they’re fantastic for calming down rotator cuff problems. It’s just a rope with some nice handles on it like this. Then it’s got this pulley so that the rope can freely move side to side here.

They typically have this kind of a strap with this, this thickening at the top of it. So if you’re listening to this right now, just go to, when you get a chance, I want you to Google shoulder pulley and you’ll find exactly what I’m talking about, you’ll probably find places to buy real cheap, these shouldn’t cost you more than $20. I think we find out for under $10 in some places, and they’re fantastic.

What we’ll do is put this pulley on a door, slide a chair right in front of it, and you’re going to grab one handle on each hand with your good side, with your hand and shoulder that isn’t hurting you. Use that hand to pull your other hand up. So, when you pull your good hand down, because you’re holding the handle on the other side that rope, you are going to use the pulley and lift your other arm and try to have your shoulder that hurts completely relaxed.

Just hold on to that handle and let your hand travel upwards, up to where you feel just a teeny bit of pain or stretch. And then come right back down. Real slow and just go up and down nice and easy up and down and allow your shoulder joint to move.

This is a nice way, on your own, to begin to get the ball and socket joint to move more freely. Now if you’re super irritated and your soldiers hurting you quite a bit, this might be tough to do at the beginning, but if you’ve done some of the other tips that I’ve already mentioned, then it should calm down a bit enough for you to do this shoulder pulley exercise successfully. And you should find that you’re better able to raise your arm and use your shoulder without as much discomfort.

Now how long to use a pulley? I would go for a minimum of five minutes continuously. You could take little breaks but sit there and pull your arm up and down for five and I would go to 10 minutes and I would do this three times a day. I sometimes recommend patients do 30 to 40 even 60 minutes.

If they’re really limited in shoulder motion, and they’re not quite where I want them to be, in preparation to begin to do more active exercises, even weightlifting exercises. So, you might need to be on this pulley for weeks sometimes I’ve even had a couple patients that go two months into using the pulley, but it’s well worth it to allow that tendon to heal.

The patients that had to go longer have typically been diabetic. The thing with diabetes is it just slows down tissue healing times and especially with tendons it can heal quite slow. So expect if you got diabetes and you’ve got a rotator cuff tear, it’s expected your recovery to just last longer, but it is still possible. As long as you got those sugars under control, it’s still possible for you to heal rotator cuff problem.

Tip number six massage.

Massage can make a world of a difference in a rotator cuff problem. Now you just have to be careful when you go see your massage therapist or if you’re getting a massage at home from a family member or a spouse that the that they’re laying off of tender spots because you’re obviously going to have some tender spots in your shoulder.

Also, some massage therapists like to stretch out shoulder joints and arms and all that. So just tell them as well that that they can do that, but you got to be very cautious and slow when going to that involved shoulder. But getting the neck muscles up here, the upper trap muscles, the neck itself, massage the back and even the arm muscles can make a tremendous difference in getting you some more mobility in your shoulder.

So, don’t be afraid to call up a massage therapist or you already got one tell them what’s going on and do a little bit of research to find a massage therapist that is familiar with handling shoulder problems. If you can do that, then I think you’re going to be a step ahead. It might cost you just a bit more, but I think it’ll be well worth it for you.

Go get a massage and have them get you to relax and do a full body massage as well while you’re there. That’ll be nice.

Tip number seven, get to an expert physical therapist.

Now what we do here in the clinic is we form a plan we make sure to diagnose the problem correctly before that, and build a timeline for when we expect this rotator cuff problem to fully heal and get people to the point where they’re overly strong and they’re tremendously confident to make sure that this rotator cuff problem isn’t going to come back in six months or a year or two years. So they can know with confidence that they’re going to avoid visiting the surgeon’s office and not going to have to get injections or take pain medications.

Most importantly, so that if they get a little bit of flare up coming back, they know what to do to make sure that it they are strengthen their shoulder, move through their shoulder exercises, do all the things that we’ve talked about in therapy, and make sure to stave off that pain from stopping them from enjoying their life. Working with an expert physical therapist will make sure to all the hands-on work, move the ball and socket joints and sends that joint is stuck and not moving well.

Sometimes there are shoulder blade issues that need to be addressed many times there’s a neck issues that are also contributing to the shoulder problems, and then we talk about movement issues that a person has with their exercises or their daily activities or their hobbies or chores they like to do at home. And we can get into the nitty gritty and in that allows us to form a very detailed plan in progressing this issue.

Now if you’re one that you’ve got a rotator cuff problem, you know it, you’ve been told that you have one. And you may even have considered having surgery or the doctors recommending that you have surgery. And I strongly encourage you to call a specialist physical therapist right away and get it looked at get it thoroughly assessed and get a plan if you can get their opinion on whether or not you can avoid having a surgery.

Because if you do have to have surgery for this, of course, there’s risks associated with that. It can end up worse in some cases, but you’re going to have to go through physical therapy anyway. Because you had the surgery, the shoulder is all stiff and tight. So you need to go through physical therapy to free up the shoulder. But what a lot of patients don’t realize it in the surgery, they think well I went through physical therapy should not have a shoulder problem again.

But the focus is different when getting physical therapy for a rotator cuff tear if you avoid surgery versus having the surgery. So if you’ve gone through a surgery for a rotator cuff tear, and then you go to the through the physical therapy after that, the focus is just on getting your motion back so you can begin to use your shoulder. It’s typically not on preventing a rotator cuff problem from happening again.

And sadly, we see that all too often that patients go get a rotator cuff surgery gets better, they go through physical therapy, and then it’s just a matter of a year or two after that before the shoulder starts to hurt them again, and they’ve returned. And the reason that that happens is because they never learned how to properly strengthen their muscles, how to move better, how to change little things in their life to make sure that that shoulder is moving well, and the rotator cuff tenant is not getting overly compressed. And that’s just not something that’s focused on when you’re you just had surgery in your learning to just get the most back in your shoulder.

Now somebody is coming in to see us before having surgery, we’re looking at prevention, not just treating all the limitations that happen after surgery.

Well, thanks for listening to this podcast, I hope that these seven tips were helpful for you. If you're dealing with a rotator cuff problem right now, I know that you probably have an excellent shot at avoiding surgery and making sure that this problem goes away for good so that you're not dealing with this and on a recurring basis.

If you're looking for some expert help, and you're in the El Paso area, give us a call our number is 915-503-1314. Or you can also visit our website to learn more about us at www.EPmanualpt.com and hit the cost and availability form once you get there, and you'll be able to leave us for details so that we can reach out to you and begin to learn more about your rotator cuff problem.

Also if you know anybody else that's dealing with a potential rotator cuff problem or they've already been told they have a rotator cuff issue or worse yet, they had rotator cuff surgery and it's coming back unfortunately. Please share this podcast with them and let them know of these tips so that you might brighten their day and help them out in avoiding the neck surgery or avoiding surgery altogether.

And one more thing if you can do me a huge favor, and whatever podcast platform you're listening to this on, please leave us a five-star review. And leave us some detailed information about how this was helpful for you or how we how this benefited you so that we might get more listen abilities, the more people can check out our podcasts and get helped out with all these tips and resources. Thanks so much for listening, and we'll talk soon again. Bye. Have a great day.

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How To Fix Lower Back Pain

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Hey there, welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh, physical therapist over at El Paso Manual Physical Therapy. And I'm going to cover with you today how to get rid of lower back pain. Now this is a simple explanation from the perspective of a specialist physical therapist. I'm going to get into the nitty gritty details about how back pain develops, how the medical field at large looks at it, and then a proper level headed way to move into fixing it for the long term.

I split this up into seven pieces. So I’m going to cover each one by one.

Number one, understand that it’s a process and not a procedure to fix a lower back pain problem.

What I mean by that, just to unpack it a bit more, is many people even in the medical field believe that fixing a lower back pain problem is just a matter of having a procedure done or a technique or a medication. In other words, they have this belief that you do this one thing, and when you’re done with that one thing, then you come out with the back pain gone or resolved. And it’s just not the case.

The fact of the matter is, it is a process to properly fix a lower back pain problem for the long term. Now it can be a procedure or a technique or surgery or something like that, to get short term relief of back pain, it is possible to get pain gone today or maybe even for a few days or maybe even for a few weeks or months. But to properly fix it for the long term where you feel like you have control over the back problem, and you know what to do to make it stay healthy and not allow that problem to come back and turn into a worst problem as time goes on. That is a process.

I see it so many times where a patient comes in for their first appointment with us here in the clinic. And they’ve got a back problem. And they said, I’ve tried this, I’ve tried that, I’ve tried seeing this person and that person, this medical expert, and this medication and this exercise and this and this and that. And many times, I’m listening to them thinking, well, you’ve tried many aspects of the process, but haven’t really been guided on how to walk through all of those pieces in a structured strategic manner to fix the back pain problem.

And that’s part of the issue, it’s just not organized, and it’s not done well. And there’s a false expectation that this one thing that you do that one medication you take, or that injection, or that one visit to the doctor is going to fix it for good. But it’s just not the case. It is a process over time, and learning has to occur.

I’ve got small children now that are learning how to read. And it’s not just one class are learning the alphabet that gets kids to read, it’s practice and replicate and development. Once they learn how to read a three-letter word, and they’ve got to expand to a five-letter word, and then you have more complications to reading like plurals and conjunctions and irregular plurals. There are all kinds of different aspects to learning how to read. And it’s a process.

It’s a process that happens over time. But in one day, you might learn one aspect of it and then the next day, you want another aspect of it and as you keep building on that over time, then you develop a process that helps you meet the outcome, which for somebody with lower back pain, they want it gone forever and not ever have to step into a surgeon’s office to get something handle there, or to get injections or medications for the long term.

Number two, don’t be afraid of big words for medical people.

The same thing when we get patients in for their first visit for a back pain problem, oftentimes, they hear stuff like degeneration, osteoarthritis, osteopenia, facet arthroscopy, they throw all these big terms out there. And it’s quite scary for patients, especially if they’re not in the medical field or don’t have an understanding. It’s quite scary for patients to hear that.

And then inevitably, what patients will do is they may get an MRI report or, or some documentation from the doctor’s office where they just remember the word and they write it down, or they start googling it, and they find all kinds of terrible things that happen in extreme cases of those conditions that are described in those big words.

But the reality is that in nine out of ten back pain cases, where a doctor or a physician or some medical expert might tell you have facet arthropathy, or degenerative disc disease or so they throw out some of those big terms, and nine out of ten of those cases, they’re fixable. Without surgery, medications and injections, and they do stay better for the long term.

It’s really the minority of people that need to have some sort of procedure done or something invasive. Or where they have to face that they’re going to have some discomfort, or some level of their condition lasts for the rest of their lifetime. But that’s really just a small percentage of cases.

Number three, wait as long as you possibly can before getting an MRI.

There are other imaging procedures that are done x- rays, CT scans, and those are a little lower level than an MRI. And what you have to understand about getting an MRI is that it’s, it’s pretty detailed, but there’s also a high risk for what we call false positives. Meaning they found something that’s on the MRI, but if we were to open up the body and look inside, it’s not really there. It’s just the way the MRI image was produced. It looks like there’s something there that isn’t, so that’s a false positive.

The reason a MRI report might say, you have arthritis at this level. And in reality, you don’t, it was just a distorted image on the MRI. So if you go get an MRI, what it does is it opens you up to potentially having conversations with the doctor about getting procedures done in parts of the lower back, that may not even need anything done.

The reality of this, and we have it proven in research is, that it’s rarely the case that where there’s a problem on an MRI, that’s the source of pain. They’ve done research studies where they have found that they’ll do MRIs on everybody, on a bunch of people that have back pain and they’ll do MRIs on people that have no back pain. And they’ll find that across the board, whether they have back pain or not, there’s positive findings are they find stuff that’s wrong with their MRIs in their low backs.

Doctors can’t really categorize who has pain or who doesn’t, if they’re just purely looking at MRIs because somebody that has no back pain could have arthritis in their MRI or some disc problem on their MRI, but they’re okay, they don’t have any problems in real life and they’re able to do everything that they want to do.

So this is good news because it is possible for you to go get MRI if you’ve already had an MRI, have some positive findings on there have some disk issues some arthritis problem, but then it resolves, it gets better. But if you had an MRI after the fact it might still be there on the MRI because you’ve converted into one of those people that no longer has back pain but has a positive finding on an MRI.

Your best bet is to pursue natural treatments, pursue noninvasive treatments so that you can avoid having the MRI and then having to end up, because doctors are recommending you to go into some sort of invasive treatment or some medicinal treatment that has some side effects potentially for you.

Number four, exercise is king.

When it comes to lower back pain across the board, if you look at all the medical literature, all the scientific research studies, some form of exercise tends to produce positive results in people that have lower back pain.

Now that’s a big huge generalization. And the fact is we get patients to come into the clinic all the time that say, they’re listing out all the things, they try to try this, I’ve tried that. Some of those are, I’ve tried crunches, and I’ve tried squats. and I’ve tried this exercise I found on YouTube and this other one that was recommended to me for my friend, and my family member who resolved their back pain, but it didn’t work for me.

The fact of the matter with exercises, finding the right ones for your specific back problem is what needs to be done. There’s likely some muscle that needs to be strengthened, or some exercises you need to start out with, and then over time work into harder exercises, because it’s a process it’s not a procedure. In order to fully resolve a back problem and keep it gone for good.

And number five, if exercise is king, then habits are queen.

What I mean by that is, what you tend to do in the body position and the way that you move when you’re doing those things. If you have a desk job and you tend to sit for longer periods of time, or if you love watching shows on TV, then you probably also sit for long periods of time. Now where you sit, the way your chair is set up, the support on the chair, if you drive a lot, the car seat that you’re in its support as well, might affect the position of your back. And it could affect the health of your back.

The habits that you’re in, greatly affect your back problem. It’s also the movement, how you move through life, the way that you walk, the way that you get up. your exercise routine that you keep or don’t keep, the habits that you do are a big deal.

Here in the clinic, when we see patients with back pain, we’re often asking them about their daily routine about their lifestyle, so that we can get the information we need to better guide them on how to modify those things, the way they sit the way they move their exercise routine so that they can build good habits or tweak their mediocre habits so that they become good habits so that it benefits your back problem.

Number six, there will be ups and downs in getting your back pain problem taken care of.

Just understand that. And I tell this to patients all the time, whenever they start out here in the clinic, that you’re probably going to get better right away, you’re going to start feeling better here within the next couple of weeks, and then expect a flare up. Because inevitably, as people feel better, they get a little more confident they start wanting to do the things that they love to do before they had back pain. And they’re not quite ready for it unknowingly, and the back pain flares up again.

It’s that vicious cycle that oftentimes kills people’s motivation to drive forward into something because they assume that what they were doing didn’t work because the pain returned. But in reality, that’s just the way life is. It’s never a linear improvement where each day is better than the last day, it gets better and better and better and better and it just goes straight up in a straight line. It’s more up and down like a like the waves are a roller coaster. One day may be good, the next thing might be bad.

But as long as you’re following the process of how to fix your back pain problem for the long term, then overall as time goes on, you’ll trend in the right direction and you should be able to take care of your back problem for good.

Number seven expert help will expedite the process.

This is where I want to recommend to you that you get in touch with an expert physical therapist or some specialist that you feel is best suited to handle your problem. Now if you’re looking for a natural solution, I definitely recommend the specialist physical therapist. If you’re seriously considering that your back pain problem might need surgery then please go talk to the orthopedic surgeon or the best person for you.

But if you’re looking to naturally resolve your back problem, an expert physical therapist can guide you on the exercises that you need to do, discuss with you the habits that you have, other aspects of your back pain problem, the history, old injuries that you’ve had, and also do have hands on work to make sure that any joints that are not moving well any muscles, tendons, ligaments, other soft tissues that need to be broken up or freed up, get freed up as fast as possible, so that when you go to do exercises, they’re their most successful for you and you can progress through them as fast as possible.

And going back to number one, it’s a process, not a procedure, so that you can shorten that the length of that process. fixing a back pain problem on your own very well could take you a year or more. Here in the clinic, we whittle it down to a couple of months, sometimes even shorter, depending on the severity and how many other factors are involved that may be longer. So getting in touch with an expert and working with them will tremendously speed up your process in order to get you the outcomes of getting rid of this back pain problem for good.

Well, thanks for listening to our podcast here. I hope that this podcast was helpful for you, I hope that my voice is getting into your head just a little bit. Whether you're running right now, exercising, or driving, or just doing chores around the house, I hope that you might stop to take a few notes and think about what it is that you're doing, and how you're handling your back problem if you've got one.

And if you don't, and you just thought this was helpful for you please share this podcast with somebody that you think needs to hear this. And one more quick request. If you've been listening to this for a while, or even if this is the first episode that you hear, and you thought that it was pretty good, please take a couple of minutes and just give us a five-star rating on the podcast platform that you're listening to this on. Whether it's the iTunes, Stitcher, any other podcast platform that we have out there, we're on all the major ones.

Please give us a review about how this was helpful for you. It helps us a lot so that we can get this podcast into the hands of other people that need to hear it so we can get more visibility or listen ability on this podcast. And as always, if you have any questions, you can call us at 915-503-1314.

If you're interested in working with us, that's a number to call and just begin to tell us a bit about your back problems so that we can see if it's the right one for us to help you with. You can also go to our website at www.EPmanualpt.com and find the cost and availability tab and you can inquire about what it takes to see us and if it's right for you to see us. And if you're just looking for more helpful resources on that same website go to the blog tab and you'll find tons of helpful blogs on how to fix a lower back pain problem in addition to other body parts that we serve as well. Thanks so much for listening and have a wonderful day guys.

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