Pain That Wakes Us Up At Night

Hey guys! This is Dr. David, physical therapist of El Paso Manual Physical Therapy.

I want to talk to all about sleeping today.

Many of our clients report that they have pain at night.

Their symptoms get worse whenever they’re sleeping. They might wake up with really bad pain.

And because sleeping can be rough for people in pain sometimes >> they don’t get very good sleep…and it turns out to be a bad day the next day.

Then many people come in asking:

“Should I change pillows?”

“Should I change mattresses?”

“Is it me sleeping face down or on my side?”

“Should I change position?”

Some of the common complaints I hear are:

“My right shoulder hurts & when I lay on it, it hurts a lot. But when I turn over to my left side, it doesn’t get that much better.”

“I wake up so stiff and painful in the morning. I think I need to get a new mattress.”

And one of the most common ones I get is this:

“Is it bad that I sleep on my stomach? Somebody told me I should sleep on my back but I just can’t do that.”

Let’s get to the root of these two questions.

  1. Should I change my mattress and pillow?
  2. Should I change my sleeping position?

Mattresses

Mattresses come in all sorts of thicknesses, firm, soft, pillow top and memory foam. It goes on and on.

The type of mattress you need is going to depend on if something’s going on with you.

If you’re in pain right now, you might need a very soft mattress to contour to your body.

This is going make sure that you get in the best position possible so that you can keep your spine in a neutral position, so that it’s not aggravating a condition.

If you’re not really in pain, you just want to be comfortable and you can’t quite get comfortable, or maybe you have a really low-level pain that bothers you from time to time, then the answer’s a little bit different…

It’s going to depend on your body type.

If you’re larger in the hips, you know you got a big booty 🍑 or you got big hips, you got a small waist, then that shape is not going to fit very good on a hard mattress.

The problem is that when one of these people lies down is it side bends your spine because of the waist and hip difference and it can cause back pain if you’re there for a long time.

It’s a similar problem with someone with really wide shoulders because of the distance from their shoulder to their head.

Whenever they lay on their side, their head might hang off their shoulder in a funny position.

Pillow Talk

That brings me to talk about pillows.

So when you’re laying on your side, make sure you have a thick pillow that can fill up the gap between your shoulder and your head.

The goal is for your neck and the rest of your spine to be in a straight line as best as possible. It’s never going to be perfect but keep it as straight as you can.

Now if you’re a back sleeper, you want to consider the curves in your spine in this way.

Does your back pop out a lot this way or does your head go forward?

Is there a lot of space in the arc of your back?

If your back is this flat to where your back lines up with your head, you probably don’t need a pillow when you lie on your back.

You can get away with no pillow or a thin pillow. If you put a pillow, it’s gonna push your head forward a lot.

And if we’re talking pillows, I don’t really think it makes a huge difference what material or what thickness or which shape or special brand the pillow is.

It’s more about personal preference and making sure that you’re comfortable.

You might find that the five dollar pillow from Walmart or Target is comfortable for you.

I’ve tried changing pillows and mattresses…still no help…

Let’s say you’ve tried a bunch of pillows, you maybe change your mattress and you’re still having pain at night.

What the heck is going on?

Here’s what I think it is.

Let’s say you scraped your knee, it’s gonna hurt, right?

The pain doesn’t go away right away.

As time goes on, the wound heals. And it hurts less.

Well that’s looking at wounds on the skin.

You can see the progress really easily on skin but what if you have an injury on the inside of your body?

You can’t see the healing progress (or lack of healing).

Those tissues still have to go through a similar healing process where over time they close up, scar up, and they hurt less.

So let’s say you have a disc injury in your spine, in your neck or back or you have a rotator cuff tear in your shoulder, that stuff needs to heal for you to feel better.

But if you haven’t figured out what to do to make it heal, it’s always going to be injured.

It’s kind of like if you always pick at the scab on your knee. Then you never let the knee heal. It just bleeds again and then scars up and if you poke the scab again then it starts all over again with [inaudible 00:04:42]

Then you never let the knee heal. It just bleeds again and then scars up and if you poke the scab again then it starts all over again.

Now the pillow and the mattress and the sleeping position start become a lot less relevant at this point. Now you gotta fix the problem at the shoulder or the back.

Now you’ve got to fix the problem at the shoulder, neck or the back.

Now let’s address the question about sleeping posture.

Sleeping posture is so tricky because you’re not conscious when you’re asleep so how do you know what position you’re in all the time?

You can try to fall asleep in a certain position but it’s probably going to change.

Now don’t over complicate sleeping position. It’s not rocket science.

Find out what works best for you.

What’s the most comfortable position? Whatever hurts the least and is the most comfortable.

If you’re a stomach sleeper and you can get away with it, doesn’t hurt you, you don’t wake up with pain in the middle of the night or in the morning, go for it. It’s fine.

I hope this helps.

I hope you know a little bit more about how to handle pain with sleeping.

I’m gonna take a nap.

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7 Helpful Tips To Help With Lower Back Arthritis


Hey everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host Dr. David Middaugh, specialist physical therapist over at El Paso Manual Physical Therapy, and today we're covering the top seven tips for lower back arthritis.

Now we see people here with lower back arthritis in the clinic all the time. It's one of the most common things that we help out. And typically, people have a combination of arthritis and stenosis and sciatica. When they're looking for help initially, they don't really know what they have going on. But maybe they've got an X ray and MRI, frequently people bring those in with them. And they'll point out on the MRI or on the X ray where it says Look, look at L-5 or L-4. I have arthritis, osteoarthritis!

When they've got that, then they are concerned because it's like I'm getting older and I've got arthritis, that stuff doesn't go away. It just stays with you for life. And they are always worried about how to begin to get help, and they're not sure who to see, or if they're going to need surgery someday. That's always a huge concern for people, especially once their back starts hurting, then they think, I don't know what to do about this and how am I going to protect this from getting worse, and I've seen my parents, they had arthritis too, and their backs are all messed up and they're on a walker on a cane or they're taking medications all the time getting injections.

If you have any of that stuff going on, you are going to want to hear these seven tips on how to get started on fixing your lower back arthritis problem. Now, just the way this works, it's not really fixing it. I'll tell you more about that here in a second. But arthritis is generally something that comes on as we age, and it can be painless. In some instances, it can be painful in other instances, it just depends if it flares up, but think of it more so as like getting gray hair or wrinkles.

As we age, we get gray hair and wrinkles and they don't really hurt. They don't hurt physically but it might hurt emotionally for some people. But if we look on the inside of our bodies with an X ray or an MRI, then you'll see that as we age and people that are older, they just tend to have more arthritis. And it's okay, it's normal. It's not it's not a bad thing necessarily.

What we're concerned about is when it becomes too severe, when it becomes out of control, that's typically a sign that there's a bad forces going through those joints, there's bad stuff happening. It's usually the way that the muscles are pulling on the joints. That's why there's bad forces on there. That's what makes the Arthritis situation progress faster and become more severe.

But anyways, I'm going to cover those top seven tips for you right now. And that way you can learn about what you can start doing right away at home. Right now, as you're listening to this podcast, you can try out some of this stuff for beak or your plan to stop doing that some of these things, because I'll tell you what to avoid as well. I think this will be helpful for you. So let's get to it.

Let's talk about the top seven tips to help out lower back arthritis.

Tip Number One Core Strengthening Exercises.

A lot of people say just go get exercise, but to be specific, we have to strengthen the core and it's typically the abs muscles, but I would also throw in the glutes, just about every single time. It's pretty rare, I'd say 9 out of 10 times, it's just an ab problem. It's an abs and a glute weakness problem that contributes to a lower back arthritis situation.

So, if you haven't really worked on your abs, and that's something you want to get going on. If you are confused about how to do it, or maybe you have already been trying it out, and it's been hurting your back more than helping your back. Then I encourage you to go over to our playlist on lower back videos in our channel for El Paso Manual Physical Therapy. There are tons of videos in there that talk about specific exercises for lower back problems and start with those. Those tend to be pretty safe and easy to do.

And if you are still having trouble, you need to get some professional help to make sure that you are doing your core exercises correctly. Because it is proven, I see it in the clinic all the time. That's how we help people is by strengthening certain muscles, in addition to all the hands on work that we do, but core strengthening is going to be your number one place to start fixing a lower back arthritis problem at home.

Number two simple stretches.

When I talk about stretches, you want to just stay in this forward and back motion. Like going towards your toes and going backwards can be beneficial. I would, there are certain stretches that I would want to avoid. That's actually tip number three. I'll cover that in a second. But its stretches where you feel like you are bending your back all the way forward or all the way backwards are generally okay to start with.

Now, what I want to point out with stretches is, they can be overdone and can actually become harmful after a while. So use them sparingly, but it's a good way to relieve the backache to relieve some tension off your back and possibly avoid taking pain medication in the short term. Just to kind of get you by for a period of time. But I wouldn't look to do stretches to cure a back problem. It's just going to get you started and allow you to avoid taking the harmful medications.

Number three, avoid twisting motions.

Typically, and this is related to those stretches, avoid twisting motions. Some people like to twist all the way around one way, and the other way, and maybe you enforce a joint to pop or click. And that can be relieving sometimes, but I would avoid it if you have a low back arthritis problem, because chances are, there's a bunch of stiff joints in the lower back because of the arthritis. And there's usually one or two joints that are compensating for all the stiff joints. And you might be over twisting that one joint that's moving way too much in creating a disc problem or a pinched nerve problem later on.

I would avoid the twisting motions. Our spines are just not designed to take a lot of twisting and repetitive twisting. So, make sure you avoid daily twisting motions, as well like twisting while doing little things, at home activities, like chores in the yard at home. If you have to stand with your feet pointed in one direction you twist over one way, or if you are sitting at a desk or cooking in a kitchen and you find that your feet aren't really going with the upper body, make sure to just reposition your feet so that they are in line with the rest of your body so that you avoid twisting through your spine. So, keep away from those twisting motions.

Tip number four drink lots of water stay very hydrated.

Our joints are reliant on our hydration so if you feel like you have not been drinking enough water over the past few months, and you are back arthritis problem is just getting a bit worse, it could very well be affected by your hydration levels. Cartilage is over 60% water up to 70% water and you have tons of cartilage. Discs in your spine are also highly dependent on hydration. And then there's fluid inside the little spine joints. The rosette joints is what they are called in the lower back. And that fluid needs to be there in order to properly lubricate the joint surfaces. So drink plenty of water.

I know the side effect is that you have to get up and go to the bathroom frequently. But I would weigh that if you are having a problem with having to go frequently versus potentially having some surgery some day because this arthritis problem was managed properly. You got to weigh those risks. So just think about that I would I'm always going to lean on the side of drink plenty of water and it's okay if you had to get up every now and then go to the potty. Just make that trip counted as exercise.

Tip number five, avoid shoes with heels.

Now this goes for both men and women. Of course, women are probably the ones that are typically going to wear heels more so than men. But men do wear heeled shoes here and there. You know smaller heals typically with like in boots or dress shoes, but that little elevation even if it's a small amount, it changes the way that your ankles are positioned when you walk, which influences the knees and hips and can translate all the way into the lower back. And generally, the bigger the heal, the more forces are going to be disrupted and affecting your back & neck.

Really, so it just doesn't allow the muscles that control the spine, the lower back to properly operate and give you the stability that is needed for everyday motions. If you have a chronic back problem, if you have arthritis in your back, I would definitely stay away from the heels until that problem gets resolved.

Now, let me put a disclaimer in here. I'm not against heels forever. I think if you are healthy, and if your back is fine, you don't have any other issues that are affected by the heels. Wear heels all you want, and it should be just fine for you. But if you are trying to avoid medications, injections and having a surgery, get off those heels in the short term and let's fix the back problems so that you can get back to her in the heels as you might like want as you want to later on in life.

Tip number six, avoid walking for exercise.

I put this tip in here because a lot of people that I meet here in the clinic and out in public, they say hey, I want to start exercising and stretches, start with walking, right? That's kind of the easiest thing to do. You just get out and put on your walking shoes and go for it. And yeah, it's an easy thing to do and it was pushed a lot back in, in the 90s and even early 2000s as a great way to start exercising. I think it's still generally accepted as a great way to start exercising.

If you don't have any sort of back problem, I'm okay with it. But if you are dealing with back arthritis, lumbar arthritis, it is not a good thing to go walking for 20 minutes, 30 minutes or more to cover many, many miles because there is a decent amount of twisting that happens through the spine when walking. And if your joints aren't moving properly, because you have arthritis in there that's preventing the motion, then you are technically doing a repeated twisting motion over and over again, and it can aggravate the back problem.

We have seen people come in here in the clinic that say, I started walking and it kind of felt better because it's stiff. I understand and my back eased up some. But then it started to bother me as time went on and I just didn't enjoy going for walks. So, if that's you stop the walking right now. There are other exercises that you should be doing. And then walking can begin to happen for regular exercising if you choose to. If you like to go hiking or you are just an outdoors person like to get out every now and then it's not a forever thing kind of like with the heels.

You want to just put a pause on the walking beyond what you'd have to normally do for everyday living, walking within your house and for work. But walking for exercise like where you go on a dedicated walk, I would avoid if you are trying to correct a low back problem, an arthritis problem in the low back.

Tip number seven, get expert help.

This is by far the quickest way to make sure that the lower back arthritis problem gets under control and managed properly. Now the reality of what we've discovered in the healthcare field over the past 20 years is that arthritis in the past, is actually Okay, as we age, it's expected as we age.

Think of it as like rust on a on a car, if you look under an old car like from the 60s or 70s, or even before that time, if there's bits of rust here and there, it's not going to impede the function of the car, your car's still going to run and you can go enjoy a cruise. But if there's a massive hole that is rusted out on the frame or on some important part of the of the undercarriage of the car, then you should get some concern and you should think Am I going to be able to enjoy my rider? Is something going to break or is this crazy? We're going to start then you got a problem. It's the same thing.

If you are looking at the arthritis in your spine, it's all over. It's just there's tons of it. Just like there's a lot of rust on the bottom of a car. You are going to have some likely long-term back issues and you can still get under control and manage it so it's not worse and avoid a surgery or having to rely on medications. But the fact of the matter is, it's just affected more joints, more cartilage in the spine. But if it's just a little bit of arthritis, in other words, if they told you that you have mild arthritis, even moderate arthritis, then I wouldn't get too concerned that's like looking at a 56-year-old car.

And if it just has mild amounts of rust or even moderate amounts of rusting but everything still works, then you have an excellent shot at getting back exactly to what you were doing before, without having to worry about having surgery one day or having to rely on injections or medications.

But getting expert help really just speeds up that process to make sure that you are doing the right exercises that you are not doing the wrong stuff. And that you are thinking about this properly so that you can learn how to take care of your back arthritis for the rest of your life. So I strongly encourage you to reach out to an expert like a manual physical therapists to make sure that your lower back arthritis problem gets under control and handled properly.

Hey guys, thanks for listening, I really appreciate it. If you thought that this podcast was helpful for you, I encourage you to leave us a five star review, that would be super awesome. If you tried some of this stuff and you had a good outcome then please leave us a bit about your story in a review, we'd love to hear that. That's always encouraging that we're helping people that are listening in El Paso, or in the area or even around the world, around the country.

We always love hearing people sharing their stories about how we might have helped them. If you are thinking that we might be able to help you out if you're in the El Paso area, call our clinic if you think that you want to get help by us, our numbers 915-503-1314 and if you just want to learn more, find out about us you can Visit our website at www.EPmanualPT.com and there's tons of free resources on there. Our blog is full of helpful information for back problems and other issues as well. You can go check it out and find more details. But anyways, I hope that you have a wonderful day and we'll talk soon.

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