Hey everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host Dr. David Middaugh, specialist physical therapist from El Paso Manual Physical Therapy. Today we are going to talk about the top four reasons for knee pain from walking and running.

The reason why we made this set of tips and advice for knee pain from walking and running is because, since all the shutdowns everyone stayed at home and had to miss going out to the gym, had to miss accessing their treadmills, and all the normal workout equipment they might have at the gym if they were going to the gym.

There has been an obvious increase in people out in the streets, out in the sidewalks, running and walking for exercise. And as a result of that, we've seen more patients in the clinic here with knee problems, hip problems and foot problems but the big one has definitely been knee pain. So, I'm going to cover with you today the top four reasons for knee pain from walking and running.

Reason number one, bad form

A lot of people don't realize how terrible their running form, or even their walking form is. And every time we get somebody with a knee problem here in the clinic, that's one of the first things we cover. You probably have been walking for years and years of your life if you have been lucky enough to have functioning legs. You have been walking and probably even running, and you wouldn't think twice about how you did it, the way that you stepped, which muscles you used, how much you raise your knees, how hard you step.

There are all these different factors that we go into depth, when it comes to walking form and running form. And then it changes at different speeds. There is likely a huge chance that the way that you are running, the way that you are walking even, is affecting your knee problem. If you take thousands of steps, even just hundreds of steps, it can put some bad forces through tissues that aren't designed to take those forces.

Because you have a running form issue, or a walking form issue, it just overloads that tissue. It might be a ligament, a meniscus, it could be a muscle or tendon as well. If that tissue gets overloaded, then it's easy to just irritate the tissue, eventually possibly tear the tissue. Definitely get some swelling in the area. But at the lowest level, your body lets you know, by just reporting pain, you just feel some pain in the area, sometimes the joint, the knee will get hot as well. And sometimes it just gets achy.

There are times when the knee won't hurt during running or walking, it actually might feel better. But then later in the day, the knee starts to ache, maybe even at night. That is a sign that there's some knee problem going on when you are running. It typically is a sign that it's a cartilage problem or a ligament problem as well. Versus if you get pain during running, it's more likely going to be a tendon or muscle problem.

That's not a hard and fast rule. Those are just likely reasons for the problem that you are facing. But if you are having any sort of pain around the time that you are running, whether it's during running, right after, or later on in the day, then there's likely going to be some running form problem or walking form problem. The best thing to do to fix your running form, or your walking form is definitely to talk to an expert, especially an expert Physical Therapist, we deal with movement.

With running and walking, there are lots of moving parts that we can address for you. And it's not a big fix, most of the time, it's just tiny tweaks that you can make instantly and begin to reduce that pain problem that you are facing in your knee.

Reason number two, too much too soon or overloading

Let's assume that you have great running form and great walking form. If all that's fine, it may be that you are doing too much too soon. In other words, you weren't walking as much as you started to walk recently. And you feel good, you felt fantastic. You enjoy the fresh air, you enjoyed the sun and everything around you. If you are on a hike, you are enjoying your hike, and you just overdid it, that can definitely cause pain in your knee.

What you have to look at is giving yourself smaller amounts of walking or running. And then gradually building it up over time to the distance, or the time that you desire to do so its going to sustain for the long term. If you are going to begin a running program or a walking program for exercise, and you want to work up to three miles for instance, you won't be able to cover three miles. I wouldn't go into doing three miles the first time you go run or walk. That's going to likely overload your tissues, and you are going to do too much too soon, and you are going to have some knee problem very likely.

You got to start out with maybe a half mile to a mile at the beginning. Do that for a week or two. It just depends on how out of shape you are. Then work your way up to a mile and a half to two miles, and then work your way up to two and a half to three miles over time. This might take you a month or two months or three months. It just depends on your specific situation.

But you need to consult an expert on this. If you are confused about how to do it. There is a lot of information online that is very helpful. You might start there too. And if you have a running friend that's gone through marathon training successfully, or half marathon training, or even ten-k training, they might be able to help you quite a bit, based on how much to walk or run at the beginning, and then how to work into as you get better and stronger.

Reason number three for any pain from running and walking is your footwear

Your shoes, especially for walkers, because people that walk may not always wear the right shoes. You definitely want to have some sort of athletic shoes or running shoes is ideal. But if you are wearing your casual shoes that don't have a whole lot of support, you might switch those out for some more athletic shoes that offer you plenty of support.

Here's why it's important. You are running, you are on your feet, you are walking, you are on your feet, there are muscles in your feet and there are muscles up into the leg that just get tired as you do more. And what those athletic shoes do for you is, they help support the position of your foot, which affects the position that your knee and hip and all the way to your low back. And if your muscles get way too tired because you are pushing yourself, then they won't support you the way that they are supposed to, because they are just not strong enough yet. But that shoe can give you that that little boost that you can last as long as you need to.

Another common mistake, related to shoes is, people just wear their shoes out. If your shoes are pretty old, or you just put a lot of mileage on them, you have walked around on them quite a bit, then it's time to get new shoes. And, there is all kinds of debates about every six months or every 12 months, or even if you didn't use them for six months, the I've heard that the materials kind of wear out. There is all kinds of debate. What I would go by, for you specifically is what feels best for you.

I can tell you from experience, I've been an avid runner myself, and I tried switching it out every six months and I tried other times as well. I couldn't find something specific. I just went by the feel I had. Some shoes I used for over a year. Currently I have some shoes that are probably two or three years old, that I still use to exercise in, and they still give me good support. They give me what I need, and they are in decent shape. I don't find a reason to get new shoes at this point me personally. But as soon as I feel like those shoes aren't supporting me, you bet I'm going to go get some brand-new shoes. And I'll be just assessing as I go on.

That's what I encourage you to do. If you are walking out there, and you are thinking to yourself, oh, gosh, these shoes that I'm about to put on are five years old. But then you might rationalize yourself and say, Well, I haven't been on a running program or walking program in five years, so maybe they are going to be okay. I'd say give it a shot.

But if you got knee pain, and you can't quite solve it, definitely go get some new shoes, it's not going to hurt, it's only going to help and that might be the fix that allows you to continue your walking routine and your running routine without having to go visit a doctor get medications or injections or anything like that. Running shoes is always a good, easy fix for you.

Reason number four old unaddressed injuries

Many people had knee problems back when they were in high school, when they played sports, and they played volleyball or football, or they were running before. They may have suffered injuries back in the day, but they never really fully got them addressed. They just laid off of them. And then now they are picking up a walking routine or running routine. They are kind of coming back but were never fully addressed.

Typically, what we find in physical therapy is that there's some muscle imbalance or some improper joint movement that is hard to feel or find out. Or it doesn't really come on unless you stress the joint like when you go on a walking program or running. But in normal everyday activities, it just wasn't enough to bother you. Those old unaddressed injuries now get magnified for you, especially if you are going to be more intense with your walking or running routine.

What I would strongly urge you to do is talk to an expert about this. Because if you can address subtle injury at the beginning of your new walking or running routine, it's going to go a lot smoother for you than if you keep running through it or walking through it, and it festers into an arthritis problem or some tear in some tissue that isn't ready to take what you are going to put it through. I strongly encourage you to talk to some experts like myself about this knee problem, so that it's not going to stop you from reaching your goals from being able to run as much as you want or walk as much as you want.

If you are unable to get to an expert, there's nobody in your area, or you just want to stay at home, make sure that you are safe at home, then I strongly urge you to consider checking out our 28-day Knee Health And Wellness Boost Program. This 28-day structured program will show you how to get stronger in your knees, strong in your hips, even your feet. It's a structured program to make sure to boost the health of your knees and make sure that you know how to address your knees strength moving forward, and how to maintain it so that you are not having recurring knee problems. Check out more about that program by visiting the link in the description here.

Thanks so much for listening to our podcast. I hope that you learned a lot about all these reasons for knee pain from walking and running. If you have more questions or you just have some specific questions about your specific problem, if you are dealing with a knee pain problem, you can reach out to us. Our phone number is 915-503-1314.

Of course, if you are in the El Paso area, we can help you directly. Now if you are looking to find us online, you can find us at www.EPmanualPT.com and you could see our website there, find all our free resources right on the homepage. You can go into our blog and find more tips and helpful advice for knee problems. I hope that this podcast was helpful for you, and we'll talk again soon. Bye

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Hey there, El Paso! This is Dr. David Middaugh, specialist, physical therapist over at El Paso Manual Physical Therapy, and I'm your host of the Stay Healthy El Paso Podcast. Today we're going to talk about misdiagnose plantar fasciitis, and specifically how to figure out your heel pain. Because if you really don't have plantar fasciitis then what the heck is it? What's going on? And how do we feel?

Get this out so that you can get back to being normal, get back to being active, healthy, and mobile in your foot and ankle without having to rely on pain medications, injections and of course, dreaded surgery.

Let's get into some specifics about how plantar fasciitis is typically diagnosed, what healthcare professionals are looking for, as far as symptoms, signs that that are classified or diagnosed as plantar fasciitis. And then what kind of treatment options are out there. I'm going to get into the controversial stuff, the misdiagnosis, and how we look at it here in the clinic at El Paso Manual Physical Therapy, and how we find misdiagnosed plantar fasciitis.

Almost every time we see a plantar fasciitis patient, somebody that comes in saying they got plantar fasciitis. So let's get into it. First off, the biggest symptoms that people have, whenever they go to see their physician, or their foot doctor, or whoever it is they are seeing as a healthcare professional for their heel pain.

When doctors, physicians, foot specialist diagnose plantar fasciitis, the number one sign they are looking for is when you get up in the morning. Your first few steps, if you have sharp stabbing pain in the heel, that tends to get better as you walk around more, but maybe never goes away or maybe it does if it's not that severe. But the classic telltale sign is that sharp stabbing pain with your first few steps in the morning.

That is often called plantar fasciitis. And there may be some associated limping that goes on. If you can't walk normal. You have to walk very, very carefully, holding on the furniture, holding on to things as you get up. And then some people report swelling as well. They get swelling around the heel area.

They get a different sensation. At the bottom of their foot, on the heel side of their foot, and some people perceive it as swelling. The last patient we had in here with these kinds of symptoms said that she felt like the pad at the bottom of her of her heel was flat. Like it lost its air, like a tire on a car. Like she said, she was like I have a flat tire and I'm stepping on the bone, instead of the cushion, the meat of the foot under the heel. That's kind of the description people have. And it can get better and worse without ever really knowing or understanding how it happens.

As far as treatment, once you tell a physician that you have this, and then they are going to automatically start writing down plantar fasciitis treatment. There are tons of ways to go with this. Of course, physical therapy is one of the treatments. I'll talk more about that later. But let's talk about other treatment options that people go towards if they have plantar fasciitis.

The simplest easiest one that people do is ice, they start icing their heel.

They will just get a bag of ice or some sort of cold thing that you can buy the story to those, those gel packs. The other thing that's commonly done is they will get a water bottle that they freeze. So it's like a cylinder shaped ice block essentially. And they will roll it on their heel and the arch of their foot. And that can be quite beneficial.

Actually, the reason for that is because it numbs the tissues, and everything under the foot and can be relieving, but it doesn't solve the root problem. Which I'll get into more about what the root problem is. But let's just go through these treatment options.

The next one is braces.

People often try all kinds of braces, the ones that you lace up the ones that have struts, metal struts or hard plastic struts on the sides. There are braces that you just wear at night. Those are called night splints. You may not use anything during the day. But there are special plantar fasciitis braces that you wear at night.

The reason why they are special is because they typically have this fabric strap that hangs off the end of the toes that is attached to the shin area of the brace. So it holds your foot and toes up, like you're lifting your toes up, and it puts a stretch on the bottom of the foot into the heel. And some people report they feel a little bit of relief with that.

Another more invasive treatment option is injections. Injections are commonly done for plantar fasciitis symptoms, specifically cortisone or corticosteroid injections because that drug is an anti inflammatory and pain reliever. The thought is that the plantar fascia, which is a tissue, and I'll go more into it in a second. It it's inflamed, and so if we inject anti-inflammatory medication, then it would help with the pain and with the long-term outcome.

The problem is that the plantar fascia is made of connective tissue. And corticosteroids are known to degenerate connective tissue with prolonged use. So, it's very much a short-term solution. And then, in extreme examples, you can have surgery. There are plantar fascia release surgeries where a surgeon will go in there and cut the plantar fascia to relieve pressure.

Now I'm not 100% sure on exactly how this is done, as far as if they cut the entire plantar fascia or a portion of it. This isn't a common surgery. So it's not something that I know a lot about because we just rarely see it. I've seen it in two people before and where they cut it on the scar, it looks like it's only a partial cut not a complete cut of the plantar fascia. I think that's how they are doing it is he just cutting an edge of it to lengthen it a bit. Just to relieve some pressure. But they will cut it the whole way is my is my hunch.

Anyway, as far as the way I think about the body mechanically, I doubt that a surgeon would completely cut the plantar fascia. In most cases when they are going where they are looking to do surgery on the plantar fascia.

Okay, so we're going to get into the PT treatment discussion about what is done in physical therapy for plantar fasciitis. But real quick, let's visit what plantar fasciitis is, physiologically, what's going on in the body so that listeners can understand how this all works.

Let's start off with the plantar fascia itself. The plantar fascia is connective tissue that attaches from the heel of the foot. And if you want a visual of this, it's easy to just go plantar fascia, Google will probably autocorrect if you have trouble spelling it. Because it is a little difficult to spell and click on the images tab, and you'll see tons of pictures of plantar fascia. It's all over the internet.

Anyways, it's a white tissue, a connective tissue. It's white because it has a low blood supply. And its job is to help maintain the arches of the foot. There are actually three arches in the foot. The main one that everybody talks about is a medial longitudinal arch, but there are a lateral longitudinal arch and a transverse arch. But its job is to primarily help hold up the medial lateral longitudinal arch.

The theory, and I say theory because this is this is not proven. This is how most healthcare professionals are operating. The theory is that plantar fasciitis develops because it's getting overly stretched out. So if you have flat arches, it's tensioning the plantar fascia. And if you do that too much, then it begins to irritate the plantar fascia at the insertion point at the heel. And that's why it's tender at the heel. And that's why people get these symptoms when they first stand up, it hurts a lot right in the heel.

That's why the treatment options are such that's why they do the surgical, the plantar fasciitis releases, that's why the braces The idea is that it's too short and needs to get stretched out as well at the heel. That's the thought process with normal plantar fasciitis. But what most healthcare professionals don't think about, that I need you to be aware of, is that the plantar fascia is not the only structure in the heel, which means it's not the only thing that can cause pain or discomfort or some problem.

You also have a pretty substantial fat pad, under the heel. There are bones there, the calcaneus in the heel bone. And there are tendons that pass in the area. Tendons are what connects the muscles to bones. They help to transfer forces to pull on things and make them move. And then the biggest culprit of heel pain in my opinion is nerves.

Nerves cover our entire body. And specifically, in the heel. There are several nerve branches that cover the heel and there is one that runs right over the insertion point of the plantar fascia. So when I do my testing, when I have a plantar fasciitis patient here in the clinic, one of the first things I do is, I do something called a wineglass test and I do a modified version of it. I'm looking to put some tension on the plantar fascia. And then I have to poke on it. And now what we'll do is we'll poke on it without tension and poking it with tension.

The idea here is that if it is truly plantar fasciitis, if it is the plantar fascia that is affected when we put tension on it because it's connective tissue, it's designed to maintain some tension to hold certain body parts together, in this case, the arches of the foot. It stresses the tissue a bit, and then if we apply pressure on it, that stresses the tissue a bit more. It should theoretically hurt most at the plantar fascia. If we apply tension to it and put pressure on it with it with the finger versus if we take tension off, we put it on slack and then apply pressure it should hurt less consistently.

When I get a patient with plantar fasciitis, I do this one last test and it is negative. In other words, it shows that the plantar fascia is not the culprits. And then I'll cross references tests with the nerve tests, where we feel and tension and affect the nerves that run into the heel. And those tests become positive. I have to make the call the diagnosis with the patient that the heel pain is not plantar fascia driven. Its nerve driven.

Now this changes everything because if its truly plantar fascia driven, then the treatment is going to look different. Now we have to ask the question of if it's a nerve problem, do we need to be stretching? Do we need to be splinting it? Do we need to be bracing it? Is injections going to help? Is doing a plantar fascia release surgery going to be effective for a nerve problem in the heel?

I always ask the question of, did the doctor that diagnosed you with this plantar fasciitis do these tests? And it's always no because they just aren't aware. It's just not something that they are trained to do or have figured out to do. And I don't expect it of other healthcare professionals. This is our profession as a manual physical therapist. So it's our specialty.

But we can figure out if it's truly more nerve or more plantar fascia or something else, there are issues in the joints of the foot that can also contribute to heel pain. And we looked at that and then there are also a situation where you can have a combination of things. So we have to judge that scenario as well and then make the proper treatment recommendations for the patient moving forward.

But what we'll settle on here is about nine times out of ten, when we get a plantar fasciitis diagnosis here in the clinic, patients coming in saying I saw a doctor, they told me about plantar fasciitis. I googled the symptoms and all over the internet, it says heel pain, limping and swelling or symptoms. So I'm Dr. Google's confirm for me and a real doctors confirm for me and I have the paper here from the doctor saying that I have a plantar fasciitis syndrome, then I'm thinking to myself, I'm not going to I'm going to take this with a grain of salt. I'm going to check it for sure, but let's check the nerves too and other things so that we can know exactly how to treat this.

Now, if it's plantar fasciitis, if it’s true plantar fasciitis, physical therapy treatment is usually focused on improving the arch. Which makes sense, because you want to take pressure off of the plantar fascia using muscles and other structures in the foot to alleviate the pressure on the plantar fascia.

But if it's not plantar fasciitis, and if it's a nerve problem, and we're doing a treatment that's treating plantar fasciitis to better support the arch, we're going to miss the boats and people can experience a situation where they go through physical therapy. Do all the foot and ankle and toe exercises, they typically will do heel raises, calf raises is another name for it, whether tippy toeing, they might do it in different ways, maybe seated to do a live version of it standing to do a harder version of it, with weights to do an even harder version of it, on a foam pad to add a balance aspect to it single legged.

They will do ankle stretches where they stand against a wall and push their heel back and put a stretch to the achilleas in the foot and the heel. They will do toe exercises as well. A common one is where they have to scratch up a towel with their toes, or pick up marbles with the toes, or I've seen some people have to pick up pins or other objects with their toes and it always makes people feel like a monkey because you're having to use your toes like fingers.

It can help to alleviate some of the symptoms, even if it's a nerve driven problem. Simply because we're just getting more motion to the foot and the heel. Motions that haven't been done before. But to truly fix the problem for the long term, so that it's not coming back in three months, or six months or a year, we've got to look at the entire length of the nerves that end up in the heel, and typically it's the sciatica nerve.

One of the questions here is the misdiagnosis that I'm talking about. One of the questions that I have to ask every patient, whenever they come in with heel pain, is do you believe you have, or do you have minor amounts of sciatica or low back pain? Because the nerve that ends up in the heel that is commonly affected, it's a branch of the plantar nerve, which is a branch off the tibial nerve, which is a branch off this sciatic nerve which starts up in the back.

So, do you have pain in your butt area, your thigh, your calf? Do you have any cramping that occurs in the calf and the thigh up in the hip? Do you have any shakiness? Have you had any back problems? Or maybe it's not really painful now but in the past have you had issues?

I'm also looking at the way their back moves, any other muscle imbalances that might be further up the chain. And I'm putting all this together to formulate the best diagnosis which will then lead us to the best treatments. And time and time again, it happens where we find an issue we, find a some sort of back pain, and usually the heel pain is so intense and so limiting that our patients often forget that they have back pain. It's not something that they are worried about.

And if they are on pain medication for the heel, that lower level sciatica pain, or back pain kind of diminishes, and they just don't even think about it. They are completely focused on getting rid of the heel pain. That they just don't pay attention to the back or thigh pain that they've been having. But have to dig there. And then I'll do some nerve tests. And once we do those nerve tests that are biased and tensioning nerves into the heel, if those tests are positive, if they create some sort of symptoms, then it's absolutely a nerve driven problem.

Then the treatment for that is completely different. We're doing some foot exercises, some foot, hands on treatments, that I have to look at the knee, we have to look at the hip, the thigh and the lower back. And oftentimes, we're doing treatment on the low back, hips, and knees in addition to the foot and that's what truly clears up the heel pain. I wouldn't even call it plantar fasciitis at that point.

The last client that we had with this, she came in and she's been having heel pain for a while. She is an active individual. She's in her 60s, late 60s I believe. She loves to do housework, gardening work. She takes care of her elderly mom, who's gone through some health conditions. She is active and wants to vote. She's a grandmother and is trying to spend time with her family. She's not really a couch potato. And she's been doing that for a long time. She helps out her husband with a business and is on her feet quite a bit for that.

So this active individual all of a sudden was put down by this heel pain and she just kind of muscles through it, but it has to grit through pain and discomfort all the time. And the biggest problem she had was when her mother was at her sickest, she's gotten better. Thankfully. Her mother was waking up at night often and our patient would have to get up to go check on her at night often, and it was just killed her, it would hurt her heels so much to have to take those first few steps at 1am and then at 3am, again at 5am again. And so it was just so painful and aggravating.

When you're in that much pain and that much discomfort, you just don't want to get up, you lose focus, you aren't thinking clearly, you want to take medications, you're grumpy. It's just a bad situation. What she found is that wearing shoes helped. It didn't completely take away the pain. Wearing shoes, it had a little bit of a heel helped.

It also didn't take away the pain though. And she tried doing normal physical therapies, she tried doing ice. She hadn't done injections or surgery and thankfully. She tried braces and splints. And it all kind of helped but didn't really solve the problem. So that's why she ended up visiting us. And once she saw us, she was convinced it was plantar fasciitis. A doctor told her it was plantar fasciitis and she's googled it, and it was plantar fasciitis.

She has all the symptoms and when I look at everything on her, I found that she had a significant back condition that is going to put pressure on nerves and can mask a plantar fasciitis symptom, but it really is a nerve symptom. So as we've gone through treatment for a nerve symptom, not plantar fasciitis. She's done phenomenal. Her getting up in the in the middle of the night is less of a problem and getting up in the morning isn't a big deal.

Now where she's at, we're about a little over a month in. She is really only getting pain or discomfort after she's been on her feet after a long day. Which is a great place to be because now it's just a matter of getting stronger in certain muscles. In her specifically, the biggest weakness that she's got wasn't in the foot. It wasn't in the lower leg anywhere near the heel. It was her abdominals. By strengthening her abdominals, what I determined is that we can take pressure off her back, because that's where she's getting the most pressure on the nerve.

So, by strengthening her dominance properly and having her use them throughout the day properly, that alleviates pressure in her back, which unintentionally, the nerves beginning at the roots in her back, which then will allow more nerve freedom all the way down into the heel. So far we've been successful and I know she's going to be fantastic as she continues to strengthen, and then doing her busy, active lifestyle, gardening, taking care of the house, taking care of family members won't be a thing for her. It won't stop her this heel pain.

That's how plantar fasciitis is often misdiagnosed. It's just taken for words from the healthcare professionals that have its heel pain, if it hurts in the mornings, especially if there are some limping or swelling going on. Then it is plantar fasciitis. But it's not dug into more than that simply because most doctors or physicians, foot specialists just are not specialists looking at the nerve aspect of this.

And if you're out there, you have heel pain and you tried the braces, the splints, you've tried taking over the counter pain medication, maybe even prescription strength pain medication, or worse yet, you've had injections or maybe even a plantar fasciitis release surgery, and you still have the problem. I'm willing to bet that you've probably got a nerve problem that hasn't been addressed. And you've been misdiagnosed, unfortunately, with plantar fasciitis when really you have what I call radiating nerve pain. That's what that means.

And no amount of orthotics or insoles will fix this problem either. It'll help, don't get me wrong. I'm not against orthotics or braces or splints. It will help but I'm talking about long term resolution of this problem. We've got to address a number of symptoms and we've got to look all the way up the chain of joints and muscles, and oftentimes it ends up being in the back and the hips.

So that's our podcast episode for today. I hope you learned a lot if you have plantar fasciitis symptoms, heel pain, and you suspect that this problem might need a deeper look into it. You can definitely reach out to us here at El Paso Manual Physical Therapy, and we're happy to talk to you about it to see what can be done about it, if it can be helped, if we're the right people to help you for that.

We can we can begin that conversation. You give us a call at 915-503-1314 and we're happy to hear about your heel pain story and want to learn more about it and see if we can help out. I hope you have the best day ever today. Bye.

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Hey, 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. I'll be talking to you today about the three big signs that you have a tension headache.

We see people here at El Paso Manual Physical Therapy for tension headaches, consistently. I wouldn't say it's the most common problem that we see here in the clinic, but we get at least one every month, or two most and they get better.

Let me just differentiate the different types of headaches and let's talk about migraines briefly for a moment, because I'm talking about specifically a tension headache. A lot of people, they have headache or migraine problems. They will start googling information and try to tease out what's a headache? What's a migraine? Do I have this type of headache or that type of headache? Because there are all kinds. But what I want to highlight here today is a tension headache.

A migraine is usually related to some sort of hormonal problem. It could be a nutritional problem or hydration problem. It's usually something that we call physiological rather than mechanical. To put the two against each other, physiological is like the cells that are inside the body, the blood flow, the fluids that are inside the body. The chemicals inside the body and how they all interact and work with each other. Versus mechanical, it’s the joints, muscles and nerves and how all those things move together.

When we are talking about a tension headache, I'm talking about a mechanical headache. The top three signs that you have a tension headache, or aka a mechanical headache:

The number one sign that everybody talks about is pain on the outside of your head.

I'm talking on the top of the head, it could be on the sides of the head, on the forehead. Some people come in saying my scalp is tender on the top of my head. Some people only have one sided head pain, you are only hurting on the right or only on the left. That's very common. Or they will say that it hurts on their forehead or right above their ear on one side. And some people just have pain on the backside of the head, kind of on the back half or back third of the head.

If you are to lie face up on a bed or a pillow, and pain anywhere around there is one of the common signs, as opposed to other headaches can create pain kind of deeper in the head, not necessarily on the on the outer surface of the head. Some headaches can cause pain behind the eye or face pain as well like around your nose and jaw. That's a different type of headache.

I'm talking about a tension headache, and we are discussing pain on the top of the head, the sides of the head above the ears, the back of the head and on the forehead as well. Another reason for this is because when you have a tension headache, there are certain nerves that can get pinched that innervate the top of your head, that on the on the outer most superficial part of your your head along the scalp pretty much. So that's where you are most likely to get all the pain sensations.

The number two most common sign is tightness at the base of your neck.

It's usually pretty strong at the base of the neck, right behind the head, on the bottom part of the head, right where the skull meets the neck, the upper most part of the neck. People usually will reach back there, and they will start digging on the muscles in the upper part of their neck. And they will say it's just tight there all the time. It just feels hard and tight and I can't turn my head all the way because it's so tight back there.

There are some muscles right there called the sub occipital muscles. And those muscles control the base of the skull against the top two vertebrae in the in the spine up there. Those muscles can spasm. They can get shortened, they can overwork or a combination of those three things and begin to not allow the joint where the skull connects to the first bone to move properly. And guess what? There are some nerves that come out right at that level that innervate the scalp, so that's why you can get pain into the scalp, and all the way to the front of the head and along the sides of the head.

But anyways, that tightness that people feel in the back of their head, or the back of the neck, right into the back of the head is the second most common sign.

The third most common sign of a tension headache is burning, achiness, stiffness and pain that can go into the neck and shoulders like lower into the neck

The pain can go into the into the neck, the middle of the neck and into the base of the neck at the bottom, and all the way into the upper part of the shoulders. The upper track region is what we call it, which is between your shoulders and neck area, and then even into the upper back and on the back of the shoulder blades and into the upper back.

The muscles that are in that region often get affected with these tension headaches. And they will feel it. They will let you know commonly that people can't turn all the way, they can turn better to one side versus the other. If they are looking to their right, it may not turn as well when they turn their head that way, but the left side is better.

Sometimes both sides are very limited. People usually just say that they feel pain, tenderness, stiffness, achiness ache Enos and oftentimes burning is a is a symptom that people tell us about whenever they've got these tension headaches.

Let's talk about treatment options for tension headaches. By far the most common treatment option that people will start on their own is over the counter pain medication. They will go to Walgreens, CVS any anywhere where they have medications, at grocery store, and they will buy the over the counter Tylenol. If it's something a little stronger that they want ibuprofen, aleeve etc. those kinds of things.

Pharmaceutical companies are so smart because they know that headaches affect so many people and that it's just so simple to go take medication, they have come out with specific medications for headaches. And usually, people will have some sort of what is it a sleeping aid along with this then they put the two medications together in one so that they can knock themselves out and also feel better. So, you can try that over the counter.

A lot of people try that over the counter and it's effective for a short term, it really is just a short-term solution that masks the pain for a bit, so that you can get through the day, or get through a few days if you need to. But I highly encourage you to use caution and be careful when taking medications because of the side effects.

Those medications, if you read the labels, you are not supposed to use them for more than a few days at a time. You need to eventually talk to your doctor. It's not a good idea to rely on an over the counter pain medication for the long term for this type of problem, for a tension headache. You have to make sure that you are careful about how you are using your medications.

Then some people will go to the doctor, if over the counter pain medications don't work, because they want a stronger prescription strength medication, and doctors of course, that's their bread and butter, they're great at handing out medications. And it's very helpful for a lot of people. But it's the same idea, you are still taking a medication, which is only going to give you short term relief.

In this case, hopefully it lasts a few days, or a week and the doctor of course is considering your overall health in the process. You have to figure that out for yourself if you want to be on prescription strength medications.

Another option that doctors will give you for tension headaches is, a lot of doctors recognize that the source of the problem is usually at the base of the skull, where it connects to that first vertebrae, so sometimes they will do injections into that area. They will do a pain injection directly in that area, and it can be pretty relieving for most people. But again, it's short lived. It only lasts for a month, sometimes a few months at most, but there's usually some underlying problem that sets up that joint to become stiff, and the muscles to become overactive and the nerves to get pinched in the area.

Injections or medications just don't fix that, they don't address stiffness and strength. They alleviate pain, they turn off the pain signals coming from that part of the body so that you can continue through your day. So it's short lived relief.

Another common treatment is chiropractic. And it's pretty effective. If you have ever visited a chiropractor, of course you know that they like to pop and snap joints so that's their bread and butter. That's what they've gone to school for it. They're usually extremely good at it. And if you have stiff joints up in your neck, they are probably going to be excellent to free it up. And they can definitely relieve the problem for the short term again.

What has to be factored in is the strength of the muscles around the neck joints, the upper neck joints so that that joint can remain free for the long term. Because it is possible to on your own, have good mobility in your neck joints, and have excellent strength in your neck bone, in your neck muscles and be able to live free of having tension headaches over and over again. It's not necessary to rely on somebody to help you out.

But chiropractic is a great place to start. Of course, it's natural, it doesn't involve any sort of medications or injections. I definitely think that it's a good place to go. But what chiropractors just usually aren't good at doing is prescribing the right kind of exercise, because that's not what they usually do. So, consider that if you've gone to a chiropractor and you've experienced the relief that they can provide for this kind of a headache problem, but if it keeps coming back then maybe you need a little bit something more.

That's when I go into this final recommendation that I make for tension headaches, and it would be physical therapy. Specifically, manual physical therapy, which is what we specialize in here at El Paso Manual Physical Therapy, of course. The reason why I highly recommend this and I'm biased of course, I'm a manual therapist myself, but seeing the results in people and seeing the long term relief that people get where they really are coming back for tension headaches over and over again, because they're taught how to self-manage.

We free up the joints here by hand. Ww do some chiropractic like maneuvers. Sometimes there's joint popping involved. It just depends on what the patient needs. In some cases, we find that the joints are actually moving okay. And it's not going to ever pop because, I don't know if you've been to the chiropractor and you've ever had the experience where they try to pop your neck and it didn't pop. Well that's usually because the joint isn't really stuck.

But you can still have that perception of stiffness in the area. And that's usually because there are muscles that are just grabbing in that area and they're not freeing up and popping the joint, or going through the technique to pop a joint can kind of free up the muscles, but it just doesn't do the same as going through some manual therapy treatment where we do specific massage techniques to free up.

But even then I tell my patients this whenever they come in for a tension headache, all the stuff that I've done by hand to you is only going to be short lived unless you do your exercises. There has to be accompanying exercises with a hands-on treatment plans so that the results can the long-term results. And you can know what to do on your own. When this comes back, if it starts to come back, there's usually some sort of maintenance program that needs to be kept up which, which most clients find easy to do. Because especially if they have an exercise routine already, it's easy to say, hey, well, you are in the gym three times a week, just let's just make sure that you are doing these exercises when you go, and you are fine, you are going to be managing your headache problems so that it's not coming back over and over again.

It's not always got to be like a physical therapy, one of those goofy looking exercises with the rubber band. We hardly ever do that here in the clinic because it needs to be something that you take home with you, that you can do at the gym, that you can do at the desk, if you have a desk job or at home, if you are at home. It needs to be something that's easily transferable and that fits into your normal routine in life.

That is how we fix tension headache problems here in the clinic naturally. Most of the time, people don't need surgery for this. I can't think of a time honestly that anybody's ever had a surgery for a tension headache specifically, if a tension headache problem continues over time, people will usually end up in pain management, or they will have an associated neck arthritis condition and they may end up having surgery for the neck arthritis.

It's usually a bunch of problems that are all stacked on each other that and then there's one that is surgical that the surgeon might operate on, but there are still problems that need to be addressed. I highly recommend clients get problems addressed right when they happen, so that they're not seeing extra healthcare professionals, and possibly having unnecessary treatments that they could have avoided.

But we help people with that all the time and they get better. They get tremendously better their clarity comes back, they can think clearly. They're not having to worry about taking pain medications every day, especially as the day goes on. It tends to get worse. They can sleep well at night. A lot of people have pain when they go to bed, they can't get comfortable. And then they get woken up at night from their a tension headache problem. And then they're just grumpy.

That's one of the, I think hidden symptoms that people don't talk about a lot. But I asked all our clients, I tell them, because I'm a big proponent of no medications, no injections and avoid surgery if you can, but there are times when it's necessary and appropriate. And whenever I get a tension headache client coming in here, the one of the things I have to ask them is, do you have any family at home that you live with? And most of the time people say yes. And then ask them when your headache symptoms are really bad. Do you think you could be nicer to them at times, and most the time people sheepishly say, yeah, I'm grumpy at times. I tell them, it's okay. That's normal, you are in pain. It happens to everybody.

They are here in the clinic usually. So I tell him, you are likely going to start working with us and this is going to get cleared up. So it's not going to be a thing here in a few months at most. But in the meantime, if you are at home with all the families and you are in pain, maybe take some medication so that you are nice to them, and your relationships can be great.

Those are times that you might consider getting some medication or talking to your doctor about an injection or medication. You have to look at the life that way because it's about quality of life. Not just avoiding surgery and injections and medication, but you need to make sure that that the people around you are happy and that you are happy around them too.

Anyways, I hope that this podcast was helpful for you. I hope that you learned about tension headaches. And if you have these signs or symptoms and you are in the El Paso region and you want to get in touch with us, the quickest way is to call us at 915-503-1314. Tell my staff that you heard this podcast and ask for a complimentary discovery visit. They will make sure to discount your discovery visit, which is a 20-minute visit to get assessed, to get checked out and learn about what's going on and get a diagnosis for the problem. You get a chance to ask questions and figure out all the details about what's involved in treating your tension headache problem with manual physical therapy.

Another option is to go on our website and look for the discovery visit option, and you can apply for a discovery visit and just mentioned that you heard about this on the podcast so that we can discount it always for you. Anyways, if you have any other questions, please reach out to us. We are happy to help, and I hope you have the best day.

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Hi El Paso, 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. I'm going to be talking to you today all about pinched nerves in the neck and shoulder.

We get clients asking us about this all the time. Sometimes they come in for treatment specifically for a pinched nerve problem. It's just gotten way out of hand and they don't know what else to do.  At times, it just is a pester that bothers people from time to time. It's not really something that they are looking for treatment for. They are actually in here for a foot problem or knee or back problem. But they still ask, Hey, I've got this issue, this pinched nerve that bothers me from time to time.

I wanted to answer the questions of what is it? Why does it happen? And what does it feel like. Then we'll go into some other tangents likely, why does it need surgery and how to relieve it. So stay tuned, you are going to hear all the details about pinched nerves and the neck and shoulder.

What is a pinched nerve?

Let me talk to you about the anatomy just a bit here. The spine is made of a ton of bones. It starts in your tailbone and goes all the way up to the base of the skull. The top seven bones right below the skull are the cervical spine on the side of those bones, between them actually, there are little holes where the nerves come out that go all the way down into your arm. And those holes are called transverse framing.

But were all those nerves come out, they all bundled together after they come out of the spine. And then they separate again and muddled together, they go through this area called the brachial plexus, which is right behind your collarbone on either side. Then once it passes that area, the nerves split up in a bunch of different directions, and they go down in your arm. Some make it all the way down to your fingertips.

The reason for those nerves is, of course, to provide the connection to the muscles so that you can use your arm and hand and everything. They also provide sensation to the skin, and they do a bunch of other things too, that aren't normally talked about. They control the blood vessels in your body, they control all kinds of other things that just aren't normally talked about and people don't really need to know in depth about unless that's your specialty.

But anyways, when we talk about pinching a nerve along the pathway, all the way from the neck to the fingertips, there are several opportunities for the nerve to get compressed or pinched. And if that happens, then it impedes the function of the nerve. It may not shut it off completely, you may not, sever the nerve or you won't cut it off. It will just usually put some pressure on it. And the way that it feels, to most people, is a low level of discomfort or pain and achiness. Sometimes it's a burning sensation. And then if they move in a specific way that they may not always know, it really bites them. I

t's a 10 out of 10 pain and just jolts the individual and they snap to stop what they are doing for moments, and then it usually starts to wear off over the course of a few seconds, maybe a few minutes at most. That's the typical presentation for pinched nerve.

If you've ever had that experience, you likely just had it once in a while here and there, but then for some people it becomes more frequent, it starts to happen more often, to the point where it happens daily, multiple times a day. Then people start to pinpoint “every time I reach out to grab the laundry from the washing machine, or to put something in the dishwasher. When I go to open the car door. I just know it's going to bite me and I'm not looking forward to it. Or if I'm in bed and I pull up the covers, it just bites me when it's a heavy blanket.” Another one is picking up a pot of coffee, or certain times when exercising, it can really set off that pinched nerve sensation.

That's typically what it feels like. And when it's really bad, when it's happening very frequently. It can be debilitating. I mean, it won't let you sleep at night, just little simple movements start to become painful, they start to set off a pinched nerve, and then that low level of discomfort, becomes a medium level of discomfort. and then eventually I high level of constant discomfort.  Because that pinched nerve is just getting irritated and more irritated over time. And it doesn't get a chance to calm down and normalize.

Why does it happen?

Let's talk about that next. How do the passageways for the nerve become compressed? Because usually there's no injury involved in most people, they just start to have this. There wasn't an accident, there wasn't a car accident, they didn't fall or get hit somehow. It just started to gradually happen.

Well, some of the most common places to pinch a nerve is right where the nerve comes out of the spine, right between the bones where that hole is the transverse frame, and if you have arthritis issues in your neck, you've had a history of neck problems. Because that hole is made up of the top half is one bone, the bottom half is another bone. If the disc between the two spine bones begins to change, shorten or lose its height, then that hole can also shrink.

Another thing is if your postures chronically not great, over time that can also cause that hole to be smaller. They call that pyramidal stenosis, this is when any hole becomes smaller in the body like you hear about spinal stenosis, that's what that would be, spinal pyramidal stenosis. So that's one way to pinched nerve.

Another one that's less talked about, but I see here all the time, is if your upper body is pretty weak, especially around your neck and shoulders, your collarbones can sink down. And because those nerves eventually bundled together and pass behind the collarbone, they can put some compression on the nerves.

Occasionally, you hear doctors diagnose patients with something called Thoracic Outlet Syndrome. And what they are talking about is that space behind the collarbone, where those bundles of nerves pass, and the bundle of nerves by the way is called the brachial plexus. If that gets chronically compressed, it can impede the function of the entire arm. Everything below the nerves there can begin to become affected.

Now what happens with people that have not the greatest posture, weak upper body, they begin to use some muscles on the sides of their neck for stability that they are not supposed to be using. They are called the scalene. The scalenes are some interesting muscles they attach from the neck to your first rib and your second rib, which are right behind your collarbone.

A lot of people don't grasp that your ribs go that high. They always think of the ribs being around their torso area, but your first and second rib are way up right at the base of your neck. Because these scaling muscles can become overused at times when they shorten, they can actually yank the first and second rib upwards. And those nerves that I was telling you, at the brachial plexus, they come right over the first and second ribs. If those ribs are getting pulled up, and then your collarbone is sunken down, it creates a sandwiching effect on your poor brachial plexus on those nerves that go down the arm.

That's another place that people often get a pinched nerve sensation. Now, to just make it worse, those scalene muscles that I was telling you about, you have three pairs in your body. You have an anterior scalene, middle scalene, and posterior scalene between the anterior and middle scalene, the front of the middle one is where the brachial plexus passes out from the spine and begins to go under your collarbone. So if you are chronically overusing your scalenes, just like any other muscle, if you use it and use it and use it, it gets bigger.

Those scalenes can get really hard and begin to compress on the nerves as well. Basically, you'll get a triple effect on those poor nerves in the in the brachial plexus area. You can get the collarbone sunken down, the ribs yanked up, and then compression from the scalenes. When we see that, it's a monster to fix, and it's not an easy task, but it can be fixed.

What it feels like?

Typically, people just get this jolt of pain when they turn a certain way. They can't get comfortable at night, they always have this low level of discomfort that runs to their neck and shoulders. They may also get knots in the area, especially around the neck and the upper trap are on the back of the shoulder. They'll get lumps. Wen those ribs pop up, they can feel really hard. They can feel like really hard lumps that be rubbed out, but they never really go away. It's because it's bone. Usually it doesn't go away. It just needs to be shifted down and those muscles need to be calmed down so that they aren't perpetually yanking the ribs up. It's a it's a process for sure.

Another common place, and this will be the last one I'm going to go into, because I can just go on and on. The last on is in the shoulder itself at the ball and socket joint. So those nerves, the brachial plexus, once they pass about the shoulder joint, they start to turn into a bunch of different other nerves. They label them differently because they go to different parts of the arm and connect to different muscles.

The big ones are the radial nerve, the ulnar nerve, the median nerve, and the muscular cutaneous nerve. That's the one that goes to the bicep. All these nerves can get pinched around the ball and socket joint. If your ball and socket joint is having problems moving, if you have issues with it. Issues like a rotator cuff tear, a biceps tear, subacromial impingement, or shoulder impingement is the more common term for it.

Those issues usually mean that the ball and socket joint is not moving normally, and because it's not moving normally, it doesn't allow for normal movement of the nerves which can begin to pinch them. What I often find, that clients are not really aware of, and I guess because this is what I studied and trained in, and live, sleep and breathe all this physical therapy stuff. But nerves move.

If you think about it, your nerves, like I said go from your neck to your shoulder, and all the way to your hand. And every time you move your arm around or your leg around, the nerves within that body part are moving along with it. And it's healthy for your nerves to move, it's necessary. It actually is vital to the health of the nerve that you get in some movement.

This is another reason why exercise is so important. But anyways, if that ball and socket joint is not moving normally or you are babying the shoulder because it's injured, it can begin to also pinch your nerves, and that can feed into that pinched nerve sensation.

When we see people here in the clinic that are coming in directly for a pinched nerve problem. Oftentimes I tell them that this is a massive problem. It's not just a one or two visit deal. We are going to see it for a couple of months likely, potentially longer, as we fix problem by problem. We have to go one step at a time.

The analogy that I like to use is, if you visualize a water hose, it comes out of your backyard, and you turn on the faucet where the hose is attached to the side of your house or the front of your house. And water is flowing through the hose and you see water coming out at the end. Well visualize, somebody's going to go step on the hose a bit, not hard enough to completely cut off the flow, but enough to impede it.

Then they put their other foot on it a little further down the hose and it impedes it just a bit further. So now you have less water flowing at the end of the of the hose. And then let's say two more people come down further the hose, and they step on it and put both feet on it. Eventually you have six spots where the hose is being impeded. Now you got just a trickle at the end, and nobody's even pressing that hard. It's just enough to cut off the flow little by little.

It's the same idea within nerves. Nerves, when they get pressure, then they can still function, but their function is impeded. It's not going to work. Normally it's reduced function. You are going to get pain of course, because that's the nerve telling you “Hey, I'm hurt!” or something's not right. But then you are also going to experience some weakness.

Eventually, if you don't take care of that you can run into other problems like a rotator cuff tear, or further an arthritis problem, or some sort of strain or sprain. Oftentimes, we see muscle spasm because the muscles freak out because the nerve connection from where it's getting pinched is not normal.

The muscle can sometimes react in a way where it spasms. It can cause that spasming. A milder sensation that people get is something called facilitations. But that's muscle twitching. A lot of people when I bring that up, they are like, Yes, I get that. I've been getting that for a while now. I'll be sleeping at night, or I'll be sitting down at work, or watching a movie or something. And all of a sudden, my tricep is just going crazy. It's just twitching, and I can't make it stop, I have to shake my arm out for it to go away. But then next time I sit down again for a while, it starts to twitch again.

That's just the muscle freaking out, it's getting pinched a bit. So those are common sensations people get and that's how we have to approach the problem. By taking one foot off the hose at a time, then taking the next foot off, and it's always a process.

In the description that I outlined for the common ways that this happens. We have to free up the neck joints to make sure that the holes in the side of the spine are open enough to allow free mobility of the nerve. We have to calm down those spaces and muscles, which can mean a combination of massage, and, of course, moving the neck joints so that they free up better. Moving the rib joints, and then also training the person on how to have better posture, and how to exercise in a certain way to calm down the scalenes.

Then we have to look at the upper body strength and find the weakest parts of that. To strengthen that, you have to look at any joints that aren’t moving well. Sometimes a lot of times the shoulder blade isn't moving very good, the collarbone isn't moving very good. The upper back joints in the spine aren’t moving very good, and all the ribs associated with that, we have to get that moving.

Sometimes we have to look at the chest muscles as well and see how flexible, or how strong those are. The ball and socket joint as well, we’ll look at how well aligned that joint is, and how the quality of motion within that joint, and then all the muscles that control it. Of course, the rotator cuff muscles are the big one. But there are a bunch of other muscles that contribute to its mobility that we have to look at.

It's a big long process and it's not even a direct treatment for the nerves. This is all indirect. But there are even times where we have to do specific techniques to the nerves to get them to begin to operate more normally. That's a whole other ballgame. But the good news with all this is that rarely does anybody need surgery.

Usually, when people get surgery for this type of problem, they are getting a surgery in their neck where they, I say this in air quotes, they clean it up, they clean up the neck. Where I said that there are holes in the side of the neck, and you can get stenosis where the hole narrows a bit. They can go in there and widen the holes surgically. But I always tell people that are looking to get that procedure done, it's probably going to close again if you don't fix your posture or address your strength. But you have to consider what got you to close the hole in the first place.

Because if you begin to undo that, maybe you have a shot at opening it up on your own naturally, without having to go in for a surgery that may only last for a year or two, before it closes down again. And then you are going to be stuck with, I'm going to have to have another surgery or go through physical therapy anyway, like I should have the first time potentially.

Now there are cases where it's severely pinched. And usually this person has of course, immense pain, but they also will have lost completely loss of strength, like they can't use your hand. The muscles in one hand look completely different compared to the other, the bicep will be weak, the tricep will be very weak. I mean, you can tell a notable, massive difference. Most people have some minor differences. If they take their shirt off and look in the mirror, they just look at their arms and they'll notice a small difference in muscle size from one side to the other.

But when it's pretty massive, when it's obvious, and other people can tell pretty easily. There's usually either a chronically pinched nerve, and when I say chronic, it's probably been years, potentially decades, or it's just been so hard that it has almost no nerve input. And it's just gotten weaker and weaker over time, very, very quickly. Over the course of a few months, it's lost all its strength.

That's a situation where you might actually need surgery. But to my knowledge, I don't know surgeons that will operate on the first and second rib to put it down. That's something that's done by hand here in the clinic. And then to increase mobility in the spine. That's a combination of hands on work from a specialist physical therapist, and then also exercise that a patient has to go through, that's guided by a specialist physical therapist as well.

But I, to this date, I've never worked with a client that ended up having surgery for a pinched nerve, we've helped everybody just fine. The good news is it gets better. We have an awesome success rate with these clients, and they get tremendously better. They get to the point where they are exercising, if that's what they wanted to do, they are sleeping fantastic.

We know we have to talk about posture, so they are sitting better at work, they are driving better whenever they are in the car, they are having a meal much more comfortably, and most importantly, they have the confidence to move without that fear that something is going to bite them in their neck and shoulder area. So, it's extremely fixable.

Thanks for listening today. I hope you learned a lot. If you want to learn more information about neck and shoulder problems, there are tons of blog articles on our website. Our YouTube channel is very active if you want to get notified right away when we release a new YouTube video, go to our YouTube channel El Paso Manual Physical Therapy and hit subscribe, and you'll get all our latest information about the neck and shoulder as well as other body parts.

I hope you have the best day and if you are out there with a neck and shoulder pinched nerve problem, please get some help as soon as possible. Don't let it get really bad.

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Hello El Paso! This is Dr. David over at El Paso Manual Physical Therapy. I'm the host for the Stay Healthy El Paso Podcast.

What we are going to be talking about today we've had tons of patients in the clinic coming in with neck and shoulder problems and over half of them have been asking this question of “Why do I have this neck hump on my back, my upper back, lower neck where the two places meet?”. They'll reach over behind their neck and point exactly to where it's at. And it's that lower neck area.

In some of these people, it's painful and others it's not. But all of them are concerned about it, they all know that something's not right. It's not normal. It wasn't there before when they were kids or when they were younger.  It's something that's kind of weird. It's unsightly, for some ladies, especially.

I see all the ladies that have this problem, they wear their hair down most of the time because they don't want that part of their back exposed, they are afraid to cut their hair shorter than, upper back length, because they want that part of their upper back, lower neck area covered up by their beautiful hair.

I'm going to go over four contributing factors to this. And then we are going to talk about the top four ways to reverse the neck hump. Because in just about everybody there is a small population that this isn't the case, but in just about everybody, the neck hump can be reversed. It may not be 100%, but it can definitely be reduced and managed properly. And most importantly, this neck hump can cause some bad stuff.

If we can reduce it, or control it, so that it doesn't get any worse, then you are in the best position to continue to be active, healthy and mobile, while avoiding any sort of unnecessary surgery, medications, or having to get injections for this problem. We see people get injections for this all the time, unfortunately.

But let me go into those four contributing factors.

Number one, contributing factor to the neck hump is posture.

When I talk about this, I'm giving this the number one, but that does not mean that it's a priority. With posture, of course, if you slouch forward, the classic computer posture, where your faces is closer to the computer, and your hands are on the keyboard, when your head juts out forward on your body, it will make that hump just a bit more.

Which is why I put posture here, just because it's the most common one that people think of. And it's definitely an easy fix relatively to the other ones. But it's not the most important thing to consider. I just want to highlight that part because just about all these ladies that are coming in right now with their poor neck humps and they are concerned about it. They all tell me, I've been working on my posture, and I just can't seem to get rid of it. And I believe them, I think that they really are at the desk, trying to sit up straighter and be taller and all that.

It's just not working out for them because it's not the biggest priority. There are other things that we'll get into here in a second, that are way more important, and that are going to affect the neck hump way more than if you just try to sit up straighter. But posture is definitely a contributing factor. If you are out there with a neck hump issue, whether it hurts or not, and you are just concerned about it, you want to definitely work on sitting up taller.

The reason that most people will lean in and put their face closer to the computer screen is because they might have trouble seeing the screen. Think about this, if you have trouble seeing the screens, it may be time to get some new glasses, get some reading glasses if you are having trouble reading small text. Or maybe you need to play with the fonts on your computer and see if you can zoom in on things. Computers these days, they are all very manipulatable that you can change the fonts and screens and zoom in and everything. Work with that if that's an option for you.

Of course, mobile devices are the other screens that we look at, our phones, our tablets, and what I always tell people if posture is a big concern for you while you are using your mobile device. You need to get in the habit of bringing that screen a little bit closer to your face, using your hand, not by leaning your head in towards the screen. So literally you have to pick up your hands and figure out a way to rest your elbows on something and get a better setup.

If you are doing this in bed or on the couch or wherever you tend to use your mobile device, you need to make sure that you are not slouching over with your head to look at your screen as best as possible. You want to bring the screen up to your head; our shoulder joints and elbow joints are best designed to move like that. It just might be that your muscles aren't as strong to keep it up there for a long time.

You have to just accommodate your posture, you are sitting posture to hold up that tablet or that phone up against your face. Also get your eyesight checked and check your sitting posture.

The second factor here, and I would go to say that this one is probably the most important which is strength.

The strength of the muscles that support the upper back, and the lower neck area is critical in making sure that the alignment, and the stability of all the joints and bones in the area are properly aligned, properly strengthen, and spaced out. It's a big, big, big deal. And that's the number one thing that I'll start fixing with somebody that's coming in for a neck hump related problem. We'll start addressing the strength.

There are many muscles in the area. For me, as a specialist, physical therapist, I'm having to dissect the case and look at every single muscle that can be contributing, all the relative strength of each muscle. We look at muscle imbalances. We look at their past activity levels. Many of the ladies coming in right now have been exercising regularly. When I talk to them about strength, they are saying, well, I've been working out I'm sore every week from going to the gym, I have a trainer even.

But they are not addressing the right muscles in the right way. That's going to maximize the impact on straightening out that neck hump. That's the problem that I'm finding. Most of the time, there is an upper trap problem. If you look at the names of muscles, the trapezius for short, in the medical field, we call it the trap. The upper trap because there are three parts to it, there's an upper, middle and lower, but it's usually upper trap strength, that's an issue and there are special ways that we have to exercise it and strengthen it over time to get the effect that we are looking for.

It's a complicated process actually. It's not as straightforward as just saying, Oh, well, he said, I need to strengthen my upper trap I have the neck hump. So I'm going to go do that. Let me look up a YouTube video and let's get this going. That is just half of the of the piece, there's much more than we need to look at. But I can tell you that if you have an neck hump problem, chances are nine times out of ten, you likely have a serious weakness somewhere. And the trap might be the first place to look.

Other muscles that contribute to this is the deep neck flexors or scalings. This might be a little too technical, but if you wanted to go look it up, you can find out the names of all these muscles and where exactly they are.

Those are probably the top three contributing weaknesses. But anyways, the let me just get into the mechanics of this, so if you are not very science minded, follow me as best as he can. I'm going to do my best to keep it as simple as possible.

Visualize the neck hump. What's going on is it's your spine that's right there. It's the upper part of your spine. It's bending over forward, because the muscles that are supposed to hold it up straight are too weak, and it tends to bend over forward because of gravity. Gravity just pulls it over. You can straighten up like we talked about with posture and that does help. But it's a short-lived effect. Versus if you are strengthening, if you are exercising in such a way that is generating the strength for your muscles to hold you up better, to hold up that part of your spine better, without you consciously thinking about it. That is where the goal is. That is where you reverse this problem for the long term so that you are not ending up with some side effect of this neck hump issue. That is going to lead into a surgery or having to rely on pain medications and injections.

I hope that is simple enough for you to understand. By the way, if you ever have questions or anything, you can reach out to us. You can go on our website, and there is a little place where you can type in questions. You can also call our clinic if you are concerned about something you want to talk to us. We have people do that all the time. So just a little side note in case you are confused about something or want to learn more.

Anyways, let me keep going here. So, posture was the number one factor that I talked about that contributes to the neck hump, strength is the number two factor that contributes to the net comp.

The third one is activity level.

If you are just sedentary, whether it's by choice or not, because that happens sometimes. An example of that would be, you have a desk job and you just have to sit in front of a computer to do your work. That to a large degree is of out of your control, you just have to do it. If you just had a child, and we see a lot of ladies get the begin to get the neck hump when they become new mothers because they are now stuck carrying a baby for months and months and months. At least until they are close to a year old maybe longer. And if you have multiple kids and you go through that multiple times.

That weakness in posture just accumulates over the years. On top of that when nursing a baby, you are hunched over, you are looking down at the baby most of the time. It's going to affect that neck part. And many women do tie this back into the old ladies that we get that their kids are all grown up, maybe they even have grandkids at this point. Sometimes they'll tie back the formation of their neck hump to when they were in their 20s and 30s, when they were having kids. And that's when it all started, and it's just gotten worse and worse over the years. Now they are in their 50s and 60s, and it's causing a problem.

That's kind of the typical story that we hear. But we do get young ladies in here as well and then they get the problem. It just affects them sooner in some different way. I'll talk more about why that is here in a second. But let's hang on activity for a bit. If you are not moving very much what happens to your muscles, those ones that are weak up in the neck, is they shut down. Muscles are very cool organs, they are super smart in that if you don't use them, they start to atrophy or they get smaller in an effort to be efficient within your body.

Of course, it's not desirable to have smaller muscles but in the grand scheme of the body, it's that's a pretty cool effect that it has. The other thing that muscles do is they almost shut off, they turn off, when you are not using it for a long time. In order to reserve energy and nutrition and all that they literally will not work. So, if you are sitting for a long time and you don't really need that muscle, because you are going to be sitting for another few hours, those muscles just turn off.

That's a bad thing when you need to become active again. And that muscle has to warm up and wake up over time. But if you are chronically sedentary, because say you have a new baby, and you are going to be holding that baby, again within minutes or hours at most, that muscle just never gets the activity that it needs. The more activity that the muscles get, the better they can operate in effect the joints that they are supposed to in the way that they are supposed to.

I want you to separate this out from strength, strength and activity are two separate things in my mind. Because when you get stronger, that strength is carried into your sedentary position, and it helps you to maintain your posture. But you can have good strength, you can be able to pick up significant weight. But if you go be sedentary for a while, even if you have that strength, those muscles can still shut down and cause problems. And you can have both come together.

Obviously, you lack the strength because you haven't exercised at all in a long time. And then you can also be sedentary on top of that. Now you are stuck between a rock and a hard place. You are weak and you are not active, and your muscles are shut down. Both need to be a component of each other.

So if you are out there and you have a desk job, or you are a new mother or have had kids in the past, and life has just never been the same for your neck and shoulders, and you got the hump developing over the years, over the decades, I strongly encourage you to go start getting stronger and definitely get more regular activity.

Just to put some specifics on regular activity, because it's very individual. I mean, if you have a desk job, you have to move every 30 minutes or so. Even if it's small, even if you just stretch, even if you just do some simple exercises that take 30 seconds or a minute. That makes a big difference over the course of a day of working at a desk all day.

Or right now we are in the COVID time so if you are stuck at home, you are working from home and then you might not be very active outdoors because they are not letting you go out, you might end up watching Netflix at home or something similar. And you are more sedentary, you just have to build in some sort of physical activity. Go do some chores around the house, or go do some yard work outside if you can get some movement so that your muscles have to work.

That would work enough to the point where you feel like you are going to sweat, like you are going to perspire. That is usually enough to warm up your muscles and use them enough to move the joints. I hope that makes sense.

Let's talk about the final contributing factor. And this is the one that's least in your control. That's why I put it here,

Your genetics.

Your genetics, who are your mom and dad and who are their mom and dads, and what kinds of genetics did you get? What kind of body type did you get? Just like we know that if you have a history of heart problems in the family or diabetes or cancer, certain cancers, you are going to be more likely to get those same problems if you don't manage your health.

Well, obviously almost all heart problems and diabetes are definitely preventable. And just because your mom and dad might have it or other relatives might have it, it doesn't mean that you are absolutely going to get it. It just means that you are more likely to get diabetes, for instance, if you don't take care of your health. But chances are that if you eat well and get enough exercise and manage your health, you are likely never going to get diabetes, but you are still genetically predisposed. And you are going to pass on that genetic that genetic predisposition to your kids and grandkids.

That's just the way life is and every race out there has its own genetic predispositions for certain problems and illnesses. It's the same thing in joints and muscles and bones. What I find is that people that tend to have longer necks, or more slender build necks will usually get this neck hump problem quicker than others. Now, it's not a hard and fast rule. So if you are out there and you are thinking, Oh my gosh, I'm have a long and slender neck, and I've always been thinner. That doesn't mean that you are going to get it.

There are other factors that contribute to this. That's just what I tend to see. I've seen short, people get it. I've seen stocky people get this issue, the neck hump problem. So, it's not a hard and fast rule, but it's just one predisposition to getting it for sure. Now, if you know that mom and dad had this problem, or grandma or grandpa had this problem, then I would be just extra concerned about it. Especially if you are becoming a new mom, or if you've had a desk job for a while, or if you are getting some sort of neck pain.

Even if you don't have the hump developing yet that's a sign that you might be getting it soon. And the hump doesn't come on suddenly, by the way, it's not something that you wake up with the next day and it wasn't there the day before. It gradually comes on over time as you get weaker and as you spend more time sedentary and your posture is not as good.

All those factors contribute to this problem and it just goes by quicker if your genetics are predisposed to it. Think about that factor as well. Now if you end up having an neck hump problem, and you are not really dealing with any pain yet, or maybe you are just starting to deal with some pain, people usually get a burning sensations, a tightness in the muscles around it. It's sensitive. When they poke back there if they touch the bones or just touch certain areas of the of the upper back, lower neck area. It's just very tender.

They tend to have problems leaning up against certain chairs. Certain couches that put pressure on that area they don't like. And they didn't have other related issues over time. So people with this problem are more likely to get neck arthritis, osteoarthritis in the joints of their spine, they are more likely to have pinched nerves and all the nerves that come out of the neck. They start getting affected over time.

On the neck hump part, what's going on inside the spine, without getting into too many technical details, the joints are being compressed on each other. The cartilage is getting squashed between the joints. When cartilage gets squashed, it gets dehydrated, which means that it's not going to move as good, because cartilage is supposed to be very hydrated so that it's slick and there's less friction between those bones.

That movement can happen. But if you have lost that lubrication from the cartilage, then the joints get stuck and if it stays like that for years and years, even decades, even then the joint surfaces begin to change. That's how arthritis develops within the joints. When we see people that are in their 70s, 80s, or 90s, and they have this neck hump problem, many times at that point when it's been going on for decades, it's not reversible much. And we are just talking about what can be done to not hurt so much. But we are conceding on that it's going to hurt. We are telling these people, you are just going to have to live with this problem. If you know there's no other options for it. You are just going to have to live with it and manage it. Here's what you can do to not make it so bad.

But if you are in your 40s, 50s, or evn 60s in that age range, you are younger, you have a great chance at actually reversing it. You haven't had it long enough to get the joint surfaces to change and become arthritic Now you can get, like I said, those pinched nerves that can turn into other stuff like carpal tunnel syndrome, it can create pain in the shoulder because of the nerves that go out into the shoulder.

When those nerves get pinched, they reduce the effectiveness of the muscles they connect to. Which can cause shoulders not work normally. And that can set up shoulder problems like rotator cuff tears, and shoulder labrum tears. There are all kinds of other shoulder problems that are affected.

Of course, arthritis and shoulders is one thing. If the muscles aren't working right, the ball and socket joint of the shoulder just doesn't move normally. And if that's going on for years and decades, then you get arthritis in the shoulder. This is definitely a root problem. This neck hump issue is a root problem to many other neck and shoulder related conditions that people end up getting surgery for, injections, or live off of pain medication. It's just, it's a bad thing.

You just don't want it and if you feel like you are getting it already. Do something about it right now! Because you can prevent a whole bunch of problems later on in life. What I always like to tell my younger patients is, if you have this thing going on, and you are in your 30s, you need to teach your kids about this, because they are probably going to have it when they get to their 20s and 30s. It’s best to educate them about how to manage their own body, if it's a genetic predisposition that you have.

Alright, let's shift gears here. And let's go into the top four ways to reverse this problem. I've alluded into a few already, but I'm going to get into some nitty gritty about this.

Number one, get regular exercise.

I talked about that when we are talking about the activity part earlier on this podcast. But let me write this down. It's critical for you to regularly, and what I mean by regularly is, at least two to three times a week. Go do something that gets your heart rate up, that gets you sweating, at least a little bit. Of course, not everybody sweats the same. But if you start to generate a bit of a sweat or you feel like you are going to sweat. If you are just the type of person that doesn't sweat much, that's usually enough to warm up your whole body and move virtually every joint in your body to some degrees, so that you are not getting them stuck and you are activating muscles. That way you are keeping them from shutting down all the way.

Especially if you are a desk worker, I would up that, I would venture to say that every day that you have to work on a computer and be stuck at a desk, build in time about 20 to 30 minutes where the activity is vigorous enough to get your heart rate up pretty good. Where you feel your heart pounding inside your chest. And of course, if you have any sort of other conditions that might be floated by exercise, talk with your doctor about that.

But if you are free of that, then go start exercising right away. For some people it's as simple as going on a jog, that tends to move all your muscles in your body. Doing some sort of workout video on TV or streaming, everybody's streams these days. Those are fantastic, and if they are shorter, if they are just 10-15 minutes long, do two of them. Do two back to back or take a short break between.

If you have a home gym, getting your workout, if you can go to the gym, if you choose to go to the gym, go to the gym and get your pump on. You need to do exercise that moves your entire body. It is critical for your overall health and it's just what I tell people. It's like flossing and brushing your teeth. If you go to the dentist, if you are not flossing and brushing regularly, they are going to tell you something about it. And even if you are flossing and brushing regularly, you are going to get tips from the dentist.

For example, when I go to the dentist as a kid, I had lots of cavities. I didn't brush very good, I never flossed, and it was always dreadful going to the dentist because I knew they were going to find a cavity or find something that needed to be work on. Pull the drill, and it was going to be miserable. Then I flipped it and I said, alright, I'm flossing every day. And I'm brushing two, three times a day. And that's sort of made the dentist is happy. But then he started to still pick on me and say, hey, that spot back there on that molar, you need to just brush it a little bit longer than you have been. Or this spot over here between these teeth, you need to get the floss all the way in there, maybe even go in there two or three times to get all the stuff out. And it was great. I began to love it at that point, because I knew I'm on the right track. I just need to do more of it, in the way that he's telling me.

Same thing with exercise. If you are already exercising you need to find which type of exercise is going to be best for your neck hump problem? For your neck issue, you shoulder issue, which one isn't going to hurt, but it's going to help. Be thinking about that.

Let's talk about strength training.

I'm talking about weightlifting or anything where you have to give it a good effort for a few seconds. This is the opposite on the spectrum of exercise. This is the opposite of cardiovascular training. On one end of the spectrum, you have cardio, where you are moving consistently, like going on a run or elliptical, or bike, those are common cardio exercises. You might be there for 10, 20, 30 minutes or more. Strength training on the other end is where you are doing something intense for just a few seconds, and you might do just so many reps of it.

Strength training is very important for this neck hump problem for strengthening the muscles. Now how you do it? Getting down to the nitty gritty specifics of it is important. What I tell people a lot of times to fixer upper trap strength, is to do overhead weightlifting exercises, doesn't need to be super heavy to start out but eventually it should increase enough to work. It's an effort and it's significant weights for that individual. When I say significant weight for that individual, me I'm over 200 pounds, I'm six two, I'm a decently big guy. I need to pick up some decently big weights.

But if you are a five, nothing, small female, barely 100 pounds soaking wet, you need to pick up some significant weight for you. And that might be starting at five pounds, or ten pounds, or not even that if you have a neck and shoulder problem. Right now you need to go even easier, maybe no weight. But you need to work up to a significant weight once you get stronger. So it's relative to the individual and their current ability. But it needs to be in such a way where the exertion that you have to put on the weights to push them up overhead, or to perform the exercise is pretty high.

On zero to ten scale of exertion. You need to be like a 6, 7, 8 or nine, a 10 would mean it's your most weight, you can lift in one or two single reps. It needs to be about that much. And you might work up to it. That doesn't mean you need to do it right away. If you have never lifted weights overhead in your life, or you haven't done in a long time, I'm not saying, go start doing it today and get to a 9 or 10. Because that's what I said in this podcast. Use some common sense and work your way up to it.

It's probably going to be months before you get to the point where you are like, Alright, I'm going to pick up the most I've ever picked up overhead because that's what I have to do. You may never even do that, you might always stick to an eight or nine. But strength training is critical.

The reason why it is so critical is because when you exert yourself like that, and it always makes you sweat, it always gets your heart rate up, and you have to mentally focus on it. You cause your muscles, you cause a cascade of hormones and other effects inside your muscles. That turns on the muscle growth, that kicks in the factors that make the most Say, Hey, we need to develop more, we need to get thicker and stronger for the long term, so that we can continue to lift these weights again. And we can hold up joints and hold up the spine better. And that's how you get that long-term effect.

The posture, the technique, the form is important because when you strain yourself that much, when say you are going to do just 30 reps and you are going as hard as you can, as heavy as you can. Form tends to fall apart, and one of the first things I do when people are pushing the weights up overhead, one of the first things I do is tell them you need to tuck the chin in, don't let you change it out. Don't get into that computer head posture, and you need to make sure your shoulders go up all the way. You need to shove your shoulders up into your ears.

That's always missed. People don't go up high enough. You need to think about bringing your shoulder blades up 110%. Most people are just going at 70. And they are not really aware of that part. I'll get behind them and I'll shove their shoulders up from the sides of their body, to give them the effect that they need. And it needs to happen like that. Every single rep. And if you are not able to do that right now, then you need to lower the weight and just practice the technique.

You might need to hang out there for a month or two or three, until you can effectively get the technique down right without hurting your neck or hurting your shoulders in some other way. Don't add weight, just stay where you are and get the technique down. It's like training wheels. We have three kids, and my older two took off the training wheels already. They are riding their bikes normally. My oldest had his training wheels on for probably the better part of a year, and we had some relatives telling us take the training wheels off. Just take them off, he's ready! And I said no, just wait he's not bothered by them. Really. He's not concerned about them, nobody's telling him anything and he's enjoying riding his bike. I don't want him to have a broken bone or fall that we could have prevented.

I would rather wear those training wheels down to a nub, until there's no more plastic left on them before letting them loose. And it was it was a great decision. Once the training wheels finally came off. He was an expert at riding the bike. That kid is all over the place now. So I was very comfortable letting him out of the training wheels. Just like that, I would want you to be comfortable saying I'm not picking up heavyweight yet until my technique is very good. Then once I'm comfortable with my technique, I don't have to think about it so much. It just happens. Now I can add the weights, and I can go on. I hope that helps.

Okay, number three is posture.

Let's talk about that. This is related to the last thing I was talking about which was strength. There's no such thing as being in the best position ever, for long periods of time because your body needs to move. Let me say that differently, you can get in the best posture ever. But you can't stay there, you just cannot stay there for more than about 15 or 20 minutes effectively. Our bodies are meant to move, remember those muscles shut down if they don't get some activity.

So, even when you are in good posture, it's the same rule that the muscles follow. You need movement. I wouldn't worry too much about posture. What I do with patients, when they come in is, we'll have a talk and I'll tell them what good posture is. But I don't make it a big deal. And I don't really visit it much after that because it's not something that I need them to be thinking about all the time. If you have gone down the rabbit hole of trying to figure out what good posture is for you, and you have researched it and you have talked to people and you have bought a device about it.

I've seen people that have that. They have little sensors that they can put on their clothes or on their body, and when they start slouching, they get a notification on their phone. And there's some that even give you a very small shock, they electrocute you just a tiny bit, to try to train you to keep your posture better. That's cool at all. And for the most part, most people, I'd say eight out of 10 don't really have terrible posture, they just have slightly bad posture. and improving it a bit, it's only going to create a minor effect on their neck hump problem. It really isn't going to make a big difference, like strengthening will and keeping up regular exercise will.

Posture is a small factor. But some of the big things that just most people aren't aware about is get your eyes checked, if you are leaning into the computer screen, because you can't see it might be a way better effect to go get your eyes checked and get an updated prescription if you wear glasses already. Or start getting glasses if you haven't. Or if you are getting a little older in age and your eyes are being affected by that. I suggest, go get some reading glasses.

I've had some people that I've told, especially the ones that were like bifocals. Of course, you have the two lenses, or there's even trifocals out there, you have multiple lenses on the same glasses. And in order to look through one lens, you have to tip your head up a bit in order to access the reading lens, the ones that lets you see close up. And then you tip your head back down to look at the upper lens, which allows you to see farther away.

Think about this. If you are keeping your head up all the time to read your computer screen. It's making you jump your chin out and possibly stick your head forward. That's going to create that neck hump situation more frequently. Maybe your glasses work just fine. But you need to go to the optometrist, the eye doctor and get yourself a set of glasses that are full size. And the entire lens is just for reading. And you keep those glasses around you whenever you are working, whenever you are at the computer. So you need to have a pair of glasses that are for reading and then your normal glasses for everyday use.

That way you are not having to tilt your head and mess with your spine, your neck position and get your back in your upper back your neck hump area into that posture. That way you can keep it up straighter. So that might be an easier thing to do then having to constantly think about, oh, I have to sit up straight. I got to make sure that my chest is out, and my head is tall, and all the things that people say.

I would go fix that first though before you start thinking all day, throughout the day about your posture. So then, that was number three, top way to reverse the neck hump. Let's talk about number four.

Get specialist help.

Undoubtedly, I think this is the most important thing. It speeds up the process. It eliminates confusion. It just gets you on the right track as fast as possible. And it's the express highway to fixing this problem. Because what I see is, people come in in their 50s and 60s and beyond, sometimes with a carpal tunnel problem, or a shoulder problem that's related to this neck hump problem. And they've been doing something about it over the years, but it hasn't been that effective for them.

They looked up some videos here and there, they've tried a couple different things. And it just didn't get them the effect they needed. And now they are faced with this neck arthritis problem. This herniated disc in their neck, this pinched nerve, this rotator cuff issue, this numbness and pain in their hand that's related to carpal tunnel, or some other nerve problem.

And it's a mess, we have to help them. I'm going to help them and that's what I do here anyway, but I have to tell them we got to free up this nerve. We got to loosen up this joint, we got to strengthen these muscles. And we have to make sure we address the hump in your neck. Because if that doesn't go away, all these problems are going to return right away, because that's the root of the issue.

By getting specialist help, it allows you to fix this problem way faster and more effectively. And most importantly, you can learn what you need to keep doing for the long term that's most effective. You can whittle down the 10 things you were doing to one or two, and what that's going to help you the most for the long term.

When I talk about a specialist, you need to find somebody in your area. Ideally, if you are in the El Paso, Texas area, of course here in the clinic, we deal with this problem all the time. We are specialists at it for sure. And hopefully you are looking for some non-surgical way to deal with this. I can tell you most surgeons out there, if you don't have some herniated disk that's pinching on a nerve, or some massive instability like were the joints are overly loose. They are not going to operate on you and the neck. They don't do anything, they'll just give you injections, if that for pain, but they don't really know what to do to fix it for the long term. And even if they find a tear or something that they can operate on, it's not correcting the strength problem, it's not correcting the posture problem or the activity problem that's still for you correct.

I've seen people go get surgeries for a herniated disc or something in the neck, they get the rods and screws put in to straighten out a segment of the spine. But if they never get the strength back, it's just a matter of time before a level that wasn't operated on becomes affected like the one that ended up getting operated on. And then that person goes back for another surgery and it's the same cycle that they get stuck in.

So, it's super important to make sure that you fix the root problem. And it's going to have to be under your control. In other words, do you have to be able to know what do I need to do when I get a little bit of pain, or when I see the hump starting to get worse. I need to know what to do on my own so that when I get to 50, 60, 70, 80 and beyond, I'm not dealing with this neck hump problem and I can have excellent quality of life and enjoy everything that life has to offer at that point in time.

So guys, that wraps up the podcast, we answered in depth the question of why do I have a neck hump, and then went into the top four ways to reverse it. I hope this was helpful for you. If you like this, please share this with somebody that you think probably needs to hear this, and subscribe to our podcast, to hear more information related to neck and shoulder problems and other body parts as well. And give us a review. If you found that this was helpful. Give us a quick five-star review. If you tried some of this stuff and found it made your neck and shoulder problem and your neck problem, better. Tell us about it on the review, just explain everything about it. I'm sure that people will benefit from seeing these reviews. So I hope you have the best day and we'll talk soon. Bye.

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Hello El Paso! This is Dr. David specialist physical therapist from El Paso Manual Physical Therapy and I'm bringing you today the Stay Healthy El Paso Podcast. We are going to be talking about why a rotator cuff tear happens, and the three-phase process to naturally fix it.

Here in the clinic at El Paso Manual Physical Therapy we follow this three-phase process. There is a lot of detail to it, I'm just going to give you an overview about it. It is possible to adapt it for yourself at home. We teach our clients here, how to do it at home. And we will get into all the details about it.

But first, I want to answer the classic question that we get from every patient that comes into the clinic as we see them regularly. With a rotator cuff tear, they always ask, “How did this happen? Why? I was fine last month and now this is happening, and my shoulder hurt me a little bit, but now it hurts a lot and I can't do a lot. And we are going to go into that.

Let's get started with just talking about what the rotator cuff is and why it's important for your shoulder.

There are four rotator cuff muscles and tendons, and just to talk about muscles and tendons real quick, muscles I think most people get, is the part of your body that when you tighten it up, it gets harder and it moves your joints like in your in your bicep. Everybody thinks about that, the flexing muscle in your arm. The part that everybody wants to have bigger, the big biceps. That's the muscle.

What most people don't understand though, is the tendon is at the end of muscles and attaches the muscle to the bone so that when the muscle contracts and squeezes, it yanks the tendon which makes the bone and that's what causes movement out of joint. So up in the rotator cuff, you have four rotator cuff muscles, and they all have associated tendons that connect to the shoulder to the, what's called the humerus, the upper arm bone, and it pulls the ball into the socket. It is heavily important for the stability and fine-tuned movement of the ball and socket joint in the shoulder.

The four muscles really quick, are the supraspinatus infraspinatus, the subscapularis and the terry's minor muscle. All four of those come together to form the rotator cuff. Now when you get a rotator cuff tear, it's most commonly in the supraspinatus tendon, which is the one that's closest to the top of the joint. And there are different types of tears. If you have a tear out there, you'll be familiar with these terms. And the way they find these is usually with an MRI.

By the way, if you haven't had an MRI then chances are you haven't been told these terms. But if you have had an MRI then this is going to be familiar to you. You might have a partial thickness tear, also called an incomplete tear and a full thickness tear are, also called a complete tear.

Partial thickness tear just means that the way the tendon tore, it's almost always the tendon, that tears, by the way, when it comes to the rotator cuff. It's only partially torn or detached from the bone. It's not fully torn or detached. So it's still hanging on. It's still being used to do its normal function in the shoulder.

Now, a complete tear means it's just about nearly detached from the bone. What I see is that most people can still use the muscle when they have a complete tear. That indicates that it's still attached somehow. But it's probably hanging on by a thread is really what's going on.

You have to understand with MRIs, they are not the gold standard to an MRI. In other words, what's better than an MRI is going in with a surgical camera and observing or looking at the tendon. That's the true way to diagnose a tear. But of course, surgeons aren't going to say, well, let's just do surgery to stick a camera in there. Just to diagnose it, they are not going to want to do that. They are only going to do that if they are going to actually do something about it.

Then MRI is the next best thing because it is an invasive, it takes a picture of the inside of the body, but it's not as good. So that means that there is a possibility for the MRI to be wrong about how bad the rotator cuff is torn. In some cases, it's completely wrong where there isn't a tear at all. But the MRI is showing that there is a tear. That's called a false positive.

In the medical world, you can also have a false negative. But anyways, what a false positive is, you go get an MRI and the doctor says based off the MRI, you have a rotator cuff tear, whether it's full thickness or partial thickness. And the way that you find out that it's false is when you end up having a surgery for it and surgeon says there was nothing wrong, and they don’t know why your shoulder is hurting because your rotator cuffs is just fine. They usually just close you back up and maybe they cleaned up a couple things that they could find, but you really didn’t have a tear. Then you had a false positive MRI.

I just want to give you a heads-up MRIs are not always 100%. Right? But what they are good at is blatant problems. They do find blatant, huge issues, but smaller issues that aren't as, as significant they might have a false positive.

Some other differentiations to make within rotator cuff tear types is acute versus degenerative.

An acute tear means that it just happened because of some event, like you were in a car accident or you fell, or you had a bike accident, something like that. Some trauma that happened that caused you to tear the rotator cuff, versus degenerative. The way that typically comes on is, there was no trauma, there was no events that happened, a fall or accident. It just started hurting one day.

It might have been something trivial that set it off like, I went to go pick up that gallon of milk or that full coffee pot, or I was picking up the laundry while doing chores at home, or I worked a lot at home, I did a bunch of gardening or this project outside. And by the end of it, my shoulder was just killing me. And the next day it was hurting even worse, and that's when I decided to go to the doctor and then they said that I have a tear.

So very likely wasn't just that coffee pot that you picked up, or the six hours that you spent doing that project at home. It was an accumulation of problems that were minor. It just happened that you passed the threshold of pain and activity to really set it off. And further tear the tendon and make it worse.

But most often these people have had some shoulder issues here and there. They may not even be painful. By the way, some rotator cuff tears are completely painless, but they just can't pick up their arm all the way, or they lose function. The way that most people lose function by the way, when I say that, it means they can't raise their arm all the way up overhead like the candle or their arm.

Reaching out ahead or at an angle, or you just can't even reach all the way out there, you don't have the actual strength or ability to get there. Reaching behind the back is very commonly limited as well like if you are trying to scratch an itch in your back, or fish the belt or the belt loops behind your behind your back. Or for ladies reaching for a bra strap behind your back is painful or just not possible with these rotator cuff tears.

Those are the different types, there are full thickness, partial thickness, and then there are acute and there are degenerative. Now as you probably already thinking, a full thickness tear is worse and an acute tear is going to be worse, and those are the ones that are more likely to have surgery. Obviously, if you have a partial thickness tear, then you have a better shot at getting better without surgery. And if it's degenerative, then usually you can fix things and prevent it from getting worse, because it wasn't some trauma that was out of your control, it wasn’t an accident.

There are cases though, and we've seen them here in the clinic where people come in with MRIs, it's a full thickness tear, and they look pretty bad. And it turns out to be degenerative. It's been going on for a while, and they get better. They get completely better, completely escaped their surgery. We've had it consistently, I'd say a few times a year, three, four, maybe five times a year, we get people that are actually scheduled for surgery. When we talk to them on the phone, I hear this from the staff that answers the phone. They'll say, Hey, you know, we booked so and so for a visit with you with you next week. And be careful with this person, because they are actually booked for surgery at the end of the month, and they are just seeing you for a second opinion.

Once we see them in person, and we talk to them, I do all the testing and we find out that they are actually a great candidate to do therapy before surgery. And I always tell them, Look, if it's that urgent for you, please go get the surgery. I'm not going to tell you not to. Obviously, it's your decision. It's your shoulder. But if you can wait maybe a month and see how this goes as far as physical therapy. Then if it's getting better gradually you have an excellent shot at rehabilitating this problem naturally, without exposing yourself to the side effects and the risks of surgery.

Plus, the big factor for that person is that they are going to learn what to do to keep their shoulder healthy for the long term. Which surgery just doesn't teach you, you just show up for a surgery date and they take care of the rest, you lie on the table and they do everything for you. And they do a great job. By the way, if you have to have a rotator cuff surgery, all the ones that I've seen, they are done so well they do a fantastic job.

There are some surgery cases that don't turn out too well as with every surgery, but I see that less with rotator cuff repairs and with certain other surgeries. It's not the worst surgery in the world to have but it's still surgery. You still might get an infection, there are still risk for other problems to happen.

Let's talk about the reasons for these degenerative tears. Obviously for an acute situation, where you fell, had a car accident, or something happened. The reason for it, there was an obvious problem. But when there is no accident, people are left wondering to themselves, what the heck, what did I do? There are four main components to this. Let me go into each one.

Posture is one, if you tend to be in a slouched posture because you work at a desk, or that's just been your posture, chances are it's not a hard and fast rule, but chances are within your shoulder joint ,within the ball and socket joint, your joint isn't properly aligned when you are in that posture. You tend to shut down some of the muscles in the area as well, which causes the ball and socket joint to not be most congruent, or the ball isn't in the socket as best as possible.

It's not out completely to where your shoulders and work but it's not seated in as best as it can be. And if you move like that if you live like that, if that's how your shoulders forced to work, then it begins to wear down on the rotator cuff tendons around it. Gradually over time, you wear it down. And when you wear it down, you begin to form a tear.

Occasionally, some people will say, yeah, my shoulder is kind of sore. When I pick it up, I just feel a little bit of pain, but I can do everything I need to, and it goes away after a while. I've lived like that for years. And then one day I was just miserable. I can’t sleep on that shoulder. I had trouble getting my shirt on and off or washing my hair in the shower. Simple things become very, very uncomfortable to do. So, posture is a big problem.

Weakness is the next one. If you just have a weak upper body, you are going to be predisposed to getting some sort of rotator cuff tear problem.

The shoulder itself the ball and socket joint. It's a phenomenal joint. The only other ball and socket joints in the body is the hip. And the difference between the hip and the shoulder is the bone structure of the hip. The socket is very deep relative to the shoulder. If you look at the bone structure of the socket in the shoulder, it's tiny. The socket itself is very tiny and surrounding the socket is a bunch of cartilage and other tissues, and the rotator cuff is a big stabilizing factor.

What you don't have to worry about in the hip is that it's more stable naturally because of the bone structure. But up in the shoulder, you have to rely on stability from these muscles. If you just are not strong overall in your upper body, you are very likely going to have stability problems in the shoulder, which leads to tears in the rotator cuff.

That's one of the first things that breaks down in the shoulder. So, if you are averse, if you don't like to go to the gym, and workout. I see this especially in females, because females just are more usually concerned about having strong legs and strong arms versus men are the opposite. They want to have strong arms or strong legs. Females tend to avoid working out their upper body which years down the road, can affect the rotator cuffs. We see a lot of these rotator cuff issues.

Now in men, when we see rotator cuff tears, it tends to happen in the jock type of person. The classic is somebody, It was a guy he's in his 50s now 60s even and very active. He has always played sports in high school, lifted weights, lovee doing bench press, because that's the guy lift the bench press. That's all the guys are going to be good at bench press. And usually they have developed some sort of big muscle imbalance within the shoulder that's causing that ball to not sit on the socket right.

It may not hurt at the very beginning, the first few years that is happening, but over time it can begin to cause a problem. And you can begin to get rotator cuff tears. Once you hit a certain threshold, that can be really painful. The degenerative type tend to happen when people hit their late 40s 50s. Usually, if they have had some shoulder problems leading up into their 40s and 50s, they definitely have them by their 60s.

So, if you are in your 30s or 40s, right now, you are already having some shoulder problems, you need to fix this issue before it's too late because you are going to end up getting a rotator cuff tear. You may already have a baby one going on, but it is possible to heal that. We will talk about that more here in a second.

Let's talk about genetics next. That's the third factor for a rotator cuff tear. Your shoulders index inside your shoulder, right above the ball and socket joint, there is a piece of bone from your shoulder blade that overhangs on top of the ball within the ball and socket joint. It's called the acromion. In the space between the acromion and the ball and socket joint, they call that the subacromial space. There are some structures in there, of course, were the rotator cuff tendons runs through there, the supraspinatus. There is a Bursa that commonly gets blamed for problems.

Everybody that has shoulder problems has some form of bursitis, shoulder bursitis. And some people go down the rabbit hole of trying to fix their bursitis when it's really a rotator cuff problem, or some other related problem. And the bursa just gets irritated because of it, but it's not the bursa's fault. It's other things fault, but people will go get injections for the bursa.

Anyways, that subacromial space can be reduced which can cause compression on the bursa. The rotator cuff tear or the rotator cuff, which can lead to a tear. And so, that space needs to be managed properly. Strengthening the muscles around the shoulder will allow the space to be more normal. Posture will also allow the space to be more normal, but some people have a different shaped a chromium which can genetically reduce the space, so they just have less margin for error. Those people with a certain type of a chromium shape need to just be extra careful that they have good posture and strength and they can manage just fine.

The fourth factor related to this chromium, the bone shape within their shoulder, is that if they are getting some rubbing on the rotator cuff tendon from that acromion of the degenerative changes within the joint is that they might get bone spurs on the bottom part of the acromion. A bone spur is just an increase growth on the bone. There are all these theories and why they occur. I'll just give you my take on it.

One of the principles in the body, one of the things that’s always true, is that the body adapts to forces. So just like if you get calluses, for instance, people get calluses on their feet, on their hands, other parts of their body, depending on what activities they are doing. A callus is a response to some sort of increased repetitive force on the skin. In order for the skin to avoid tearing and breaking down, it gets thicker, and it gets thicker to protect itself from when you go back to do that activity it won't tear.

The other parts of the body do that too. Just like if you go lift weights, if you are picking up weights to strengthen your muscles, your muscles feel the force of the weight that you are having to lift, and so they adapted by getting thicker and stronger. So that you can pick up the weights again easier and maybe even pick up more weights.

Tendons do the same thing. We know that bones do the same thing if you have osteoporosis for instance, it's recommended that you go do resistance exercise or body weight bearing exercise, because it tends to make the bones thicker so that they can be better able to sustain forces and not break as you get more active. Those bone spurs develope to protect the bone from breaking or becoming irritated or injured somehow. It's a sign that something's not right. In the overall mechanics, the way that you move your posture, your strength as well.

There is some imbalance somewhere, somehow, that's causing this bone spur to develop. If you have bone spurs on the bottom of your acromion it's going to decrease that subacromial space. And it can directly put pressure on your rotator cuff tendons, and just cause a tear to come along faster than other people. So that's just a genetic thing that some people have.

That covers the four reasons for getting a tear.

Let's talk next about how to naturally fix it. I'm going to give an overview of our three-phase process for naturally fixing rotator cuff tears. It's quite complicated. Whenever we take a rotator cuff patient on, we have to first see if we can help them or not, or if they really are the best candidate for surgery and they should go there first.

We always educate them. We say, Hey, if you are going to go have surgery, that's cool. That's your decision, or it's very appropriate, I recommend it too. I think you should go. You are not going to do too well, if we try to skip out on surgery, it’s just that far gone, unfortunately. But I tell them, you still need to go through physical therapy after. It's almost always the case. Whenever you have a rotator cuff repair surgery, you get sent to physical therapy. And the point of that physical therapy is to just get your motion back. Because you are going to be all stiff and swollen from your surgery, you are going to have to be wearing a special sling. You have to wear that thing at night, it's miserable to sleep with it, you are going to be in pain for a long time, usually three or four months after surgery.

That's just normal for everybody going through rotator cuff surgery. But all the physical therapist is going to get you to do, is begin to raise your arm up, move it out to the side, and move as your shoulder allows. They have to follow protocol and get it back to normal. When I say normal and air quotes because most people that have finished rotator cuff repair physical therapy after the surgery, they are not normal. They'll tell you, when I pick up my non-surgical arm, my good arm, they'll say, look you can come up and look at my other arm and they are lacking, good 20-30 degrees. They are not normal yet.

But they have made a lot of progress. Obviously, they couldn't do anything near that after surgery. So it's more functional for them, they can get through life, but they may still not be able to sleep on that shoulder, they may still have trouble using the arm and may be weak. Doing housework around the house is still a challenge for them.

There is still a lot of rehab that needs to happen on their own. Or they may still go to therapy for a while. And really, it takes the better part of a year to recover fully from a rotator cuff repair surgery. Then I tell these people that are going to go get surgery, that they still have to fix the underlying problem. If you think about it, if you had a degenerative tear, there is something about the way that you are moving, the strength of posture. Maybe your genetics is a factor, but there is something that you can modify, so that you don't have to have a surgery again. Because we see that happen.

We see people to get a rotator cuff tear, they go get a surgery, and then a couple years later, they are back at the surgeon's office because their shoulder hurts again, and the surgeon is saying you are developing another tear in the same area, I'm going to  have to go do a double repair. And I always tell them, there is something that wasn't fixed. That wasn't the surgeon’s responsibility. They likely did a fantastic job. It wasn't the surgery coming undone. It’s that there are issues that are unresolved here that need to be strengthened or moved better.

If we get somebody who's a good non-surgical candidate, they should have physical therapy like we have here, the specialized type of physical therapy that we offer, then I start telling them great, I'm glad you decided to start physical therapy with us, you are going to learn how to manage this, so you don't have to have surgery. And if for some reason you have surgery, you are going to know how to manage this beyond that, so that you are not having to have a second surgery.

Let's get into the three-phase program that we take people through.

Phase One, The Healing Phase.

We sometimes skip this phase, but it just depends on where the individual is at. If we get somebody in here, let me use our last case for example. Or the last one that we had in here, she is in her mid-60s, very active, loves to garden, loves to do projects around the house. She is a retired teacher and loves spending time with her family, loves baking, loves cooking, she just loves life and loves taking care of her family and her home.

It just slowed her down tremendously. Once she hurt her shoulder. She wasn't sleeping well because you couldn't lie on that side. It was a right shoulder and even if she turned over on her left side, she just couldn't get as comfortable as normally before the surgery. It just impeded her sleep so much. Of course, her everyday activities were affected too, she couldn't shower, or do her hair. She couldn't put on her clothes comfortably. Putting on her bra was just extremely difficult with her right shoulder.

Her complaint was pulling up her pants. She said, once I get my pants up to my thighs and have to put some effort into it to get them all the way up. It really hurt her shoulder. So that was a big deal, whether she had to get her husband to help her out and that's tough. Having to get help to put on your clothes when normally you don't need it. She was definitely flared up and probably had a very acute situation.

But let me back step on that. She did have a degenerative tear, but it was very flared up right now. In other words, it was hot. It wasn't like she had some accident. Because we get some people that on their own before they get to us, they, they flare down when they are flared up. so they are not as as acute as we call it. They are not in as much pain, they can move a little bit better, but the tear is still there and needs to be fixed.

Well, this woman was definitely flared up when she came in, she couldn't pick up her arm very much, and she was having trouble with all that stuff. So one of the first things we will do with these people is we tell them, we need to get that tissue under control, it's just like a cut your skin and you got some bleeding happening, the first thing you got to do, whenever you get a cut on your skin, is to control the bleeding and bandage it up. It's probably going to bleed a little bit throughout that first day, maybe even into the next day, until enough healing occurs, that it stops bleeding and then you just have to baby it for a while so that it scars down and becomes normal again.

Same thing in the shoulder within these tendons. So, we told her is to get a sling, the type of thing that you get if you went to the hospital with a shoulder problem. Just a basic sling one that they sell like at Walmart, or like a CVS or Walgreens, a lot of grocery stores even have them, they shouldn't cost them more than 20 bucks, some are as little as 10 or even less. It doesn't have to be a hardcore sling. Get yourself in that sling and you need to cinch it up really good so that it shoves your shoulder up.

Because what I want to have happen and I'll show people here in the clinic, I need that ball shoved up into the socket so that it's not tensioning the rotator cuff. Because if you don't have that ball shoved up into the socket, then essentially, it's hanging out. Gravity is pulling it down, especially if you have a tear, a full thickness tear, and you are just not going to bring the edges of the tendon together as easily to facilitate healing. So, you need to have that sling on for most of the day.

We tell these people, you can sleep without it, as long as you can get decently comfortable, but during the day, you need to use it and it serves two purposes, that first one that I talked about to bring the ball up into the socket. But the second one is to reduce your usage of it, because automatically when you are in that sling, you are just going to use that arm less, you are going to  have to open the door with the other hand, you are going to  have to not do that chore the same way that you were doing it before. It's also going to tell other people as well that you are hurt, so they'll be more likely to help you out so that you can baby that shoulder and let it flare down.

Once you flare it down, then we are in a position where we can work some of the other muscles and start rolling into…

Phase Two, The Cleanup The Motion Phase.

That's what I call it. When I say clean up the motion, we are looking at the way that all the muscles work together to control the ball and socket joint. Usually there is an imbalance between those two and we have to clean up that motion, clean up that imbalance so that the forces are normalized and you can take pressure off that tendon that was torn. Then you can begin to heal a bit faster.

We also have to look at the shoulder blade, and all the muscles that attach to it and move it around. Because that's a big deal. If your shoulder blade is moving properly, the outer part of the shoulder blades serves as the socket for the ball and socket joint. All those rotator cuff muscles attach on to the shoulder blade and then they connect out through the rotator cuff tendons to the ball part of the joint and they bring them together and stabilize them. We have to make sure that the shoulder blade is moving well.

Then what gives stability to the shoulder blade is the spine, the upper back and the neck. We have to look at the muscles that give stability there and the posture that's going on within all three of those areas, the spine, the shoulder blade, and then the ball and socket joint. We have to clean up the motion. There are some simple logic exercises to do. They need to be done quite repetitively.

Sometimes we need to hang out between the healing phase and the cleanup motion phase for a while. Once the healing phase is pretty much over and there isn't much pain in the shoulder at all except with a few motions. Then the motion is cleaned up. Largely people are learning how to move better, then we can enter the third and final phase.

Phase Three, The Strengthening Phase

This is the longest phase typically, because most of the time people that have this degenerative type of tear, have chronic weakness, they have avoided working out their upper body or they just haven't worked out in such a way that's helpful for their shoulder.

We have to begin undoing a lot of weaknesses that have been going on for years, maybe even decades. Strengthening muscles just happens slowly and just need lots of reps over time. We start out people with some daily exercise and then, as they go gets stronger, we can reduce it to every other day. Then usually it's just a couple times a week as they start maintaining the last kind of lesser reach phase, a fourth phase, if you will, as a maintenance phase.

Which I'll tell people about, but I don't typically see them throughout that process. That's what they keep up on their own. And that maintenance phase is critical, by the way, because if they don't do it, if they don't stay in that maintenance phase. They don't keep up the exercises that they are supposed to, which are usually some sort of overhead lift, some two basic exercises, then they can begin to regress and get their rotator cuff tendon injured again or irritated again.

Those are the three phases, the healing phase, the cleanup the motion phase, and the strengthening phase. Then the bonus extra phase that you should hang out in, is the maintenance phase. But the first three are the ones that we carry people through here in physical therapy all the time.

That’s everything that I wanted to talk to you about for the podcast here. I wanted to answer the question of why a rotator cuff happens, what are all the details surrounding the muscles, the types of full thickness versus partial thickness, acute versus degenerative, and all the reasons that a rotator cuff tear can happen, and then how to go about naturally fixing it.

Just one last thing about the natural fix, we see people with full thickness, degenerative tears here all the time, and they get better. What we know in the research is that, it is possible to fully recover, and maybe not even have your rotator cuff tendon attached again. But to move your arm normally, you can compensate with other muscles. It's my belief that the tendon does actually regenerate and heal. We just don't have solid research for it. Hardly anybody that gets better goes back when they are feeling great and doing everything that they were doing before. That nobody ever says hey, can you go get him another MRI just to see if it's connected or not.

I've never heard of that happening. Maybe it's happened here and there. But I haven't seen any research studies about that. It's just not studied. A lot of people in the medical field will say, Oh, well, it's torn and you are not going to get it back. But we don't have any hard evidence to say that. I think it's really a false statement, but it's a common belief, and it's imparted on patients a lot.

But I've seen it happen here in the clinic over and over again, where people get better, but they don't want to spend the three or four grands to go get another MRI. They just say you know what, I'll pass, I’m back to normal anyway. So, think about that whenever you are considering surgery or considering how to go about fixing your rotator cuff problem.

Anyways, I hope this has been helpful for you. If it has, please share this with somebody that you know needs to listen to this. Somebody else who also has shoulder problems, possibly rotator cuff tear, if you think that this information was helpful for you, I encourage you, actually let me request that you leave a five star review for our podcasts that would really help to get visibility out there, to get more people to learn more about a rotator cuff problem and see other ways to help their shoulder besides medications, injections and surgery there.

There are natural solutions out there for rotator cuff problem. Subscribe to our podcast if you want to keep getting more information about this, I highly encourage that. We put out content every week about different body parts. Right now, we are talking to all about shoulder and neck problems. But please I love the review. I’d love for you to subscribe and share this as well. Thank you and I hope you have the best day.

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Hey, welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Today we are going to talk about the three most important muscles for good lower back health.

The reason why I'm doing this podcast is, I've had tons of questions lately, from people with back problems that asked about which muscles they need to focus on, and which exercises they need to do to focus on those muscles. Now, being that this is a podcast, I can't really show you exercises. So, I'm going to talk about some concepts more importantly. And I say more importantly, because there are tons of exercises out there, and a good exercise for certain muscle may be a bad exercise for another muscle.

So it really is situational and it depends on your specific situation if you have a back problem, there are different things that you could do at this time versus, if you are a little bit better. Then an exercise that may have hurt you in the past, could actually be beneficial to you now. Specific exercises I don't want to go into right now. We'll talk about the muscle groups instead. So let's get into it.

The top three most important muscles to improve your lower back health.

Number one is definitely your abdominal muscles. Everybody kind of gets that. It's no secret in the healthcare field, especially if you are in the healthcare field. People know that your abdominals should be strong in order to have good back health. But what we often see people do is it they will come in saying I've been working on my abs, I've been doing sit-ups, I've been doing planks. They will show us exercises that they've found on the internet for ab exercises. And they will tell us it hurts their back. Sometimes it even creates a popping or clicking sensation in their back, and it leaves their back even more sore.

Personally, I've had that feeling myself, so I know exactly what they are talking about. But what we are finding in these people is that if you think about the abdominal muscles, those muscles run from the bottom of your rib cage, all the way down to the top of the pubic area, on the pubic bone and the muscles wrapped around your sides. Through tendons, they connect directly to your lower back bones, and the vertebrae so they can influence the lower back quite a bit.

Within your abdominal muscles, you have four different muscles. You have the rectus abdominus, the transversus abdominus, the internal obliques and the external obliques. And because these muscles are so large, as far as the space that they cover, they are actually really thin, almost paper thin. But they are broad muscles. They function differently in different areas.

When we talk to people, here in the clinic about their abs, one of the questions that I asked them is: Well, you have been working your abs out for your back problem. Sorry, it hasn't been helping you. But tell me this, when you work out your abs, do you find that your upper abs mainly get the workout, or is it your lower abs? Or is it everything? What part of your abs is getting affected more when you exercise your abs?

We get all kinds of mixed answers, and really depending on the way that their back problem is presenting, and the specifics of their back problem, if it's more of a disc issue, or a stenosis issue, or a nerve issue, you want to target different parts of the abdominals. You also have to test to see where you are weaker. Some people can know where they are weaker, they can feel it, and some people have no clue. They can't tell themselves where they are weakest and that's our job here in the clinic.

We will muscle test specifics of the muscles and be able to tell you “hey, you are weak in your upper abs or your lower abs, or there is evidence that you have been using your upper abs more so than your lower abs, because of the way that other muscles look, how they counterbalanced the loss of muscle balance.”

So be careful when you are working out your abs, whenever you are doing an exercise for your lower back, it should not hurt your back, it should not hurt during or right after, it shouldn't leave your back more sore. The effect that you should feel is that it didn't hurt one bit. In fact, it is improved a bit. And over time, as you continue to exercise, it continues to improve and feels better. But let's move on to the second muscle.

The second muscle that's critical for lower back health is the glutes. People don't really think about this one because it's not really a part of the lower back in most people's eyes. It doesn't connect to the vertebrae, the spine bones of the lower back. It's more in the hips, around the hip joints. But these muscles are so important, because if you think about them in the grand scheme of your body, they are huge. They are enormous muscles. They are thick and they are large as far as how much space they cover.

Which means that they have a lot of power and a lot of potential for stability in the rest of the body. And because they control the hips and the pelvis, which are the foundation for the rest of the spine. Without good quality control and strength from the glute muscles, you are likely going to run into some back problems.

One of the next questions that I ask people, whenever they are dealing with a back problem is I'll say, “whenever you go to exercise, like you told me you like to do lunges or squats or run or jump on the bike, or anything like that, how often do you feel the burning in your butt muscles?” About nine 9 out of 10 people say never, once every few months at most. And that to me is evidence that they are not targeting their butt muscles very well.

Many times, it's just a small tweak on an exercise that they are already doing to get the butt muscles to turn on the glutes, so that they can begin to do that same exercise in a way that is making their glutes work.

Classic example that we see here is with runners, most runners don't feel sore in their glutes unless they are sprinters. Srinters tend to use their entire leg muscles. You just have to if you are going all out sprinting. It's nearly impossible to do it without using every muscle. But for somebody who's doing more distance running, more cardio based running, not sprinting, somebody who is running, let’s say for several miles, 5K, 10K or longer distances, or even half marathons and marathons. They will usually say that they are sore and their hamstrings and their quads and their calf muscles. Hardly ever their glutes or if anything, they get just a tiny bit sore in their glutes, but it's heavily the quads and hamstrings.

This is evidence to me that they are not properly using their glutes, because glutes are a huge muscle like I said. Now some people say, well, the quads and the hamstrings are pretty big. And my response to that is, is Yeah, but they are mainly moving the knee, and the knee just bends and extends, the glutes control the hip joint and the base of the spine. There is way more importance on the glutes.

If you think about the quad muscles themselves, they are long and slender, they only have one direction to pull, the glutes actually have multiple directions of pull. If you pit them against each other, glutes are way more important than the hamstrings. Your quads are for just about any activity.

Some common exercises that that we give people, will be some lunges and squats. We do our lunges and squats quite different than what most people think or have been shown. Oftentimes when we show people the way that we do squats or lunges, they will say, I never learned it this way. How come nobody ever showed me how to fire my glutes? They will be surprised, and some people will say, Well, I played sports all through high school, and I worked out in the gym with my coaches and my trainers. And nobody ever showed me how to do it like this.

My response to them is always, I'm sure that they had the best intense and that they were doing the best that they could with an entire football team or volleyball team or whatever team you are on. But they just don't have a physical therapist background like I do. I just look at the body differently. Luckily, they probably didn't have a whole lot of injuries. What they've done has been successful most of the time. So that's what they've been continuing to do.

But over time, over the course of years and decades, that's when that wear and tear starts to build up. And that imbalance starts to build up where they get stronger in their quads or weaker in their ABS or glutes, and then it begins to affect the lower back. It's totally fine, don't feel bad if you are like holy moly, I've never been using my glutes on squats and lunges, and I've been doing them for years and years and years. You have to find a way to make sure that your glutes are working on a regular basis that's critical for back problems.

But let's go into the final muscle group that is important for your back health. The low back muscles. Now this is obvious, a lot of people are probably thinking I’ve been doing exercises for that, but I feel that I need to get stronger, my lower back muscles are weak. What I want to do is dispel a few myths about this area and just to be specific, I'm talking about the muscles that are directly on the lower back. If you reach behind yourself and touch the sides of your spine. If you move off to the right or left, of the center of your lower back, those are the muscles that I'm talking about.

They are called the lumbar paraspinal muscles in the medical books. And they work whenever you bend backwards. Or a common exercise that people do to work them out is the lie on their stomach, and then pick up their arms and legs. Sometimes this exercise is called the Superman. And it makes the lower back muscles contract quite a bit. Now, these muscles are kind of small, and some people they get really big, and that's not a good thing.

Their primary function is not really to stabilize the back but more so to decelerate certain movements like flexion and rotation, for instance. You got to make sure that you are not too heavily strong on these muscles they are more for control. Isolating them out is typically not a good idea. Now sometimes we do tell people to do that. But most of the time we want people to not really feel their lower back muscles work really hard.

A common exercise that aggravates these poor low back muscles is deadlifts, and squats can do this as well. But we often have people that have had a history of doing weightlifting and they will say oh yeah, deadlifts killed my back every time I do it, I feel tight in my lower back. And if I do it enough, I'm stuck in bed for a while, I can't get up, I can't move around very good. And my back muscles just feel way too tight, especially on one side more than the other.

That's usually a sign of an imbalance. Their back muscles have been too dominant during the deadlift motion and they haven't used other muscles that they should be using to accomplish a deadlift. Those poor back muscles are rebelling, they are letting the person know that they are not doing what they are supposed to be doing. They are supposed to be stability muscles, not big weightlifting muscles.

A trick that I do with a lot of our back pain clients is we actually want them to get relatively weaker in their lower back muscles. Now I'm not saying you need to get weaker, like lose muscle, that's rarely ever a good thing. It's more so that we want the other supporting muscles to get stronger so that your lower back is relatively weaker, it's keeping it same strength, but we are not going to strengthen it aggressively like we might other muscles. We do it so that it is more in in proportion strength wise, so that the balances normalize around your lower back.

But these lower back muscles, they are critical. You can't live without them. They are extremely important, and you need them in good health. Most of the time when we are talking about good health for the lower back muscle, we just want them to not spasm, that's a common place for people to get spasms. If they are getting spasms, it means that they are using them way too much and using them inappropriately.

We are teaching people to move better in a way that doesn't make them spasm, we are teaching them to avoid twisting too much, because that will tend to set it off. Twisting is sneaky and it happens all the time. Whenever we are at home doing chores and awkward positions. It's almost inevitable to twist. But if you can take a moment to think about how you are going to move so that you don't twist, it can save you a heck of a lot of trouble later on in life.

Sometimes you have to twist it's just the nature of the situation that you are in. I can tell you I never twisted so much in my life until I started having children. When they were little, we had to get them in and out of the car seats. And getting a child into a car seat, especially when they are really little, and they have that big carrier those are pretty heavy. When they are like a year old, and they are almost starting to walk, and they are getting big and pudgy, that's a heavy baby. In order to get them in and out of the car in the backseat, it's just a little rough on the back. Sometimes you have to twist a bit. Now, I'm not saying you can't ever avoid twisting, but you want to minimize it to make sure that your lower back muscles are healthy and happy.

So there you go guys, those are the three most important muscle groups. It's more of a strategy than it is some specific exercises to do. Like I said, the specifics come from a well thought out plan on how to improve a back problem. I don't like to give out specifics online just because, I haven't had a chance to look at you. I haven't had a chance to figure out how your joints are moving, or how the muscle feel. What your specific actions activities are throughout the day.

The best is to get all of that factored in to diagnose and then develop a well thought out plan that we begin to systematically execute, and march to better health. It's amazing. I love helping people with back problems because it's like week to week, they are getting better, a little better, a little better. And you are going to love it when we hit the plan, right as we intended. When we get to week three or week four, and I tell people Yep, this is exactly where I expected you to be, you are sleeping better, you are moving better. I know, it's not completely gone. But you are definitely on the path to avoiding a surgery.

When we get to the end of the program and they are sometimes lifting weights, they are running, or they are back to their normal previous activities, at least. Oftentimes, they want to do even more than that. And I tell them, Hey, you got to just keep up a few things. It's not going to be as intense as it was the beginning. But at least now you know what you need to do to keep healthy for the long run.

We talk with them about these three important muscle groups, and we go into detail about what to do about each of them. So that once our clients end with us, they are no longer seen as for treatment, they know how to manage any flare ups they are going through later on in life, if the back problem starts to come back a little bit, in six months, or a year or two. They jump right back onto those exercises that they they've done in the past. And they have a much better sense of awareness about how to help themselves, before having to call somebody for specialist help.

So hey El Paso, I hope that this was beneficial to you. I hope that you learn something about your back problems, and the muscle groups that are important. How to decipher which exercises are good and not good, and when to pay attention to what you are feeling and all that. If you have any questions about your specific back problem, please give us a call. Our phone number is 915-503-1314 and talk to us about your back problem. We'd love to learn more and see if we can help you out and see if we are the right people to help you out.

Especially if you are looking to avoid having a back surgery. If you had a parent or grandparent that that had a back surgery or suffered from back problems, and you saw them in not the best shape at the end of their life, or are they getting older right now, and they are still around, thankfully, but not moving too well. Their quality of life isn't the greatest. The last thing we want is for you to end up like them.

If you have no back problem right now that's similar to theirs. More often than not, definitely 9 times out of 10 it is preventable. You can get a better without ever having surgery. And you don't have to be taking pain medications. You don't have to have a bottle ibuprofen on your grocery list every few months because you go through it. You don't have to have injections. If you are getting injections, that's just medication that they inject directly into the spine. And it's not getting you stronger. It's not teaching you to move better. It is not preventing the surgery. It's really just putting it off. So make sure that you do the right treatment to make to get this problem healthy again, we don't want you to have a lower back surgery that you could have avoided. Anyways, I wish you the very best day and we'll talk soon again.

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Hey there, El Paso! This is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Welcome to the Stay Healthy El Paso Podcast. Today our topic is going to be the secret cause of lower back pain.

Now for people that suffer from low back pain, especially if they have gone to see a doctor for it, and they have had any sort of diagnostic imaging like x-rays or MRI. They have probably been told that they have a disc injury, a pinched nerve. For set arthritis is a common one, and stenosis. There are all kinds of common problems that doctors will spot on an MRI or an X-ray as well. Degenerative disc disease is another one that comes to mind.

But something that is rarely ever, to tell you the truth, I've never seen a physician or anybody that saw somebody for back pain, bring this up besides physical therapists, because this is the way that we think, something that I've never seen anyone talk about and this is the secret here is hip problems.

Hip problems in people can come off as painless a lot of times, and usually the way that it feels is tightness in some of the muscles around the hip. Occasionally you do see somebody that has some severe hip arthritis and they have obvious limitations. They can't walk right, they limp, they have trouble getting up and down from a chair, going up and down steps or curbs.

I'm not talking about those kinds of people that have an obvious hip problem. What I'm talking about is somebody who has an obvious back problem. That's where they hurt. That's what bothers them day to day, are off and on. But they don't really think about their hips. And the reason why this is a secret, because one of the first things that we do here in the clinic, whenever we get somebody with a back problem, is of course, we ask them about their back problem to tell us what's going on. Let's get to the bottom of it.

But once we start checking people by hand, I always check their hip. I have to see how much that hip goes up, down, sideways, and rotates, because the ball and socket joint of the hip has tons of motion. Of course, you have to have a pair of hip joints. And if one of your hips is not moving correctly, and it's forcing the other hip to move extra, it will likely cause your back to move differently. If this has been going on for a long time, then usually it contributes to some major back problem.

I can't tell you exactly which back problem is going to contribute to, but it just does cause problems in the back. Oftentimes, what we are doing here in the clinic in addition to treating some disc injury or arthritis in the in the lower back, where we're dealing with some hip problem as well, some muscle imbalance and arthritis problem in the hip, a lack of mobility in the hip. Lack of knowing how to use the muscles properly. That's actually a common thing. People don't even realize that they are not using their muscles, right. And it's so cool to see some pretty quick changes in most people.

Once we start working on their hip, once they get full mobility in their hip, they feel like they get a chance to do some exercises and get more stability through their hips. The back pain tends to reduce significantly. We will do this in combination with the back treatments, the direct back “hands on” treatment and exercises that we do for backs.

But it's the combination of these two that really get people to the point where they are feeling tremendously better. But I just wanted to do this podcast talking about this, because if you are out there and you're listening to this, and you've had x-rays, MRIs, you've been trying to get to the bottom of what your back problem is, and you're frustrated because nobody really knows what's going on. And in fact, sometimes you get people to bring in their imaging, their x-rays and MRIs, CT scans. And they say that they look pretty normal. That they have mild arthritis, mild things going on in their in their back. But the doctor told them that that's normal and that there is nothing that can be done.

It's so cool to get that client in here and be able to check out their hips and tell them, your right hip does not bend anything like your left hip. In fact, you've lost 20 degrees of motion here, 30 degrees of motion there, and your muscles on this hip versus that hip don't feel the same, they're stiff, they're tight, and the strength isn't the same at all. So we end up treating the hip and the back gets better.

I just want to make sure that you know that that's a possibility. And in some cases, we see a knee problem that can contribute to a hip problem too. We have to look at the entire chain of joints. If you think of a chain. The chain of joints would be the foot, the ankle, the knee, the hip, and then the low back and all the joints in the low back. Any problem in any of those joints, they all affect each other. But the hip joint is the most mobile joint of all of those.

It's critical to make sure that we look closely at that joint. Look at every possible motion that that it can do. All the muscles that control that hip joint as well are important to check out. There are tons, when talking about the glute muscles, people just think of the gluteus maximus usually, but there's gluteus maximus, gluteus minimus, gluteus medius. There's a tensor fascia that contributes to the glute function as well. There are deeper glute muscles like the piriformis, the superior inferior muscles, the operator muscles internus and externus, the quadratus femoris there are all kinds of muscles. The hamstrings even run through there too and can affect the glutes and to a lesser degree there are nerves as well, that are in the area.

If those nerves are affected, they can change the strength of the muscles throughout the hip. So we sometimes end up looking at the nerves and it's more of a nerve problem that's affecting the hip. But that's what we do here. That's what we specialize in is getting to the root of the problem, peeling back all the layers, looking at every possible contribution. Holistically, to a back problem.

What we tend to see is people that have gone through other treatments, and then they come in here to our clinic, they usually have the response of Wow, nobody's ever looked at my hip like that, or my back like that, or whatever body part we're looking at. Nobody's ever thought to check this, or thought to check that, or nobody's explained how all this works together.

That's just normal for us here. We look at every single aspect that could be contributing to a single problem and the way that we see it here at El Paso Manual Physical Therapy, is that it's what's necessary, and we are going to take the time to do that. Because if we don't, then we're shortchanging you we are not fully looking at the problem.

What I've seen happen in other places that I've been at, as far as working as a physical therapist is, there just isn't enough time. The skill level, the technique level of the healthcare professionals is specialized differently than what we are here. They may be really good at something else, but they're not good at looking at the root of the problem.

I'll give you a clear example. For instance, most PT clinics around the country without knowing it, without saying it, they are really specialists and helping people after a surgery. So after a back surgery or hip surgery, like a replacement or discectomy and they are really good at getting people to move again and walk again and get back up on their feet.

But helping somebody out who has not had a surgery is a whole different ballgame. That requires a different kind of specialty. And that's what we do here. We rarely ever see surgical cases. About 99.9% of our clients here are our clients that are trying to avoid surgery and injections and medications. When they come here, they haven't been to another clinic like ours, and they are always surprised at how in depth we have to go. Because after dealing with the surgery, a surgical case, it's usually pretty straightforward.

We as a physical therapist, from my perspective, any way I can, I usually have the surgical report in front of me so I know exactly what was done. The surgeon’s notes, and the patient will tell me, and you can obviously see an incision on the patient wherever they were operated. As a physical therapist, we have like x-ray vision, so we know what's under the skin at that point. What muscles are there. What joints are there. What nerves are there. And it's pretty obvious to know what needs to happen next. But in somebody who's never had a surgery before, somebody who's trying to prevent the surgery,

There's no incision, there's no surgical notes. There's no obvious sign of what's going on. You're having to work off of what the patient's telling you. Asking the right questions is critical, making sure that we pull the right information out. We have to figure out what they have done in the past, what's helped, what has hurt, how their day goes, how it feels at night, how it feels during the day, there are so many components to putting it all together to make sure that we can get this person to the point where they can confidently go back to the activities they were doing before they started having problems, and truly escape surgery. As well as know what to do, to know how to prevent the problem from coming back so that they're not having to take pain medications or go get an injection at some point later on.

So there you have it. That's the secret to lower back pain - the hip. Checking out the hip and all the details around the hip and finding the root of the problem.

Hey, guys, thanks for listening. I hope that this podcast was beneficial for you. If you have any questions, if you're dealing with a back problem, and you have questions about it, or you think you might have a hip problem, feel free to give us a call at 915-503-1314 and we can talk more. I look forward to talking to you in the next podcast episode. Have a great day.

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Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh. I'm a physical therapist and I'm the owner of El Paso Manual Physical Therapy.

Today we are going to be talking about herniated discs, bulging discs, and degenerative disc disease and there are other things that happen to discs as well. Specifically, after we go over what is all this stuff and how does it happen? We will also talk about what the treatment options for disc injuries like these are. Let's just get into today's topic.

What is the difference between a herniated disc, a bulging disc, degenerative disc, or a slipped disc? There are all kinds of problems that can happen to discs. At the root of it all is a disc injury. You can get into specifics based on what doctors find, if you have ever had an MRI, if you have had a back problem, maybe you are listening to this right now, because you have a disc problem, and you want to learn more.

You might have looked at your MRI report or your X-ray report. Or you might have talked to the doctor, and they told you about what was going on. They may have used the word, you have a herniated disc, or they told you that you have got a bulging disc, or you have degenerative disc disease. There are all kinds of things that can happen to a disc.

The difference is in a herniated disc, where there is a bubble that comes out and may press against a nerve, it may press against the spinal cord. It's usually just in one section of the spine. Whenever you hear about this happening in the lower back, they can go out directly backwards, towards the middle of the spinal cord, or they can go out to the side and not affect any nerves. Or they can come out halfway between the back and the side where there are some nerves that run out the side of the back.

That can be problematic as well. Bulging disc means there is an entire section of the disk that is wanting to come out. It's being shoved out a bit, but it's not a bubble. It's like a love handle that appears on the disk.

Degenerative disc disease is when the disc itself is degenerating, it's actually becoming injured over time. You might get some hardness that develops inside the disc, there could be cracks in the disc. It's like an old disc, essentially. But you don't have to be old necessarily to get it, and they can get older at one level relative to another level. Which means that you can have degenerative disc disease at L5, for example, but not at L4 or L2, or L3. We have to ask questions about how that got there. And we will ask those questions in a second.

Another common thing that you hear about is a slipped disc. Slipped discs are kind of unicorns in my opinion, they are not really found in medical research. You might find a mention here and there. But as far as what it actually looks like it's not really a thing. The picture that people have, when referring to a slipped disc, is that the disc actually slides out of position, and detaches from the bones.

What most people don't understand is that the attachment between a disc and the bone, the vertebrae, the spine bones, it is extremely stuck. There is no way it's going to slip out. It just doesn't shove out one way or the other as a whole, it might herniate. You might get problems with the disk, but to get it to detach from the bone., I've never seen that happen or heard of that happening. Slip disc, I think is kind of a misnomer. It's not a good term to use, but it's still commonly used out in the in the medical field.

Now, why do these problems happen? And are there different reasons for each one, and in my opinion, it's usually the same similar set of problems. It's set up different types of disc injuries. It just depends on your genetics. It depends on what your spine is predisposed to, getting the type of injury that is predisposed to. If you have parents that had similar disk problems, and that's probably why you are having that.

In small cases, it can be some specific activity that you repetitively do that sets you up for this type of problem. But they all have the same root problem, there is usually a muscle imbalance between the muscles that stabilize the spine. Now, we are going to go somewhat deep here, into the root of why a disc problem happens. So follow me and pause if you need to think about the words that I'm using for a second, I'll try to keep it as simple as possible.

In a lower back, and we are talking about the lumbar spine, the lower back. You have three main muscle groups that create all this stability in your lower back. One is the back erectors, these are the muscles that run up and down the sides of your spine. On the backside is your abdominals. Of course, the abdominals are on the front, but they wrap around and attach through tendons to the spine on the back, and they also attach to the pelvis, the bones that the spine connect to at the bottom.

Then the third group would be your hip flexors, specifically your psoas muscle, which is a hip flexor, and it runs from your thigh bone, the top part of your thigh bone deep in your hip, and it comes through the front over into the pelvis and attaches up into the lumbar spine.

Between these three muscle groups, you have to have proper balance so that your spine can stay in the best position possible so that the discs can work properly. Now if you have an imbalance and your spine doesn't stabilize properly, then you are going to present eventually with one of these problems that we've talked about. Either a herniated disc, a bulging disc, or some sort of disc problem. It's just a matter of time.

Usually the thing with discs is, they are super resilient structures. They are tough. They are hard to dissect. When we have cadaver dissections in physical therapy school, those things are super hard, you can't cut through them very easily, it's actually easier to cut through the bone than it is to cut through the disk. And disk tissues are designed to be shock absorbers. So they contribute to your spine working like a spring.

Now, if you google a picture of the spine, or if you by chance can see a skeleton around you or something like that. I'm in the clinic right now, so I'm looking at the skeleton. You may not be but if you just pull up a picture of a spine, or if you think about it, if you have a pretty good memory of what they look like. All the bones stacked right on top of each other right from the tailbone. Then you have the 5 lumbar vertebrae, that all stacked on top of each other. Then you have 12 thoracic spine vertebrae that all stack up on top of each other. And then you have the neck, the cervical vertebrae that all stack up on top of each other.

Our bodies are designed to stack, we are bipedal. In other words, we walk on our two feet versus dogs or cats or cows, they walk on four feet. Their spinal structures are different than ours, they have similar components, but the way that they are designed to absorb the forces of gravity and be able to get around, there are small variations that allow us as humans to be able to stack vertically.

Now the problem comes going back to that muscle imbalance. If you have an imbalance, the one of the first things that tends to happen is the lumbar spine, the low back begins to lose its position. You'll start to curve in your back too much. You are no longer stacked vertically, and you start to curve too much. Now what I'm telling you right now is a bit controversial in the medical field, because there are all this argument about how much curvature should you have in your lower back, same thing for the neck and mid back. But I don't think that there is one specific number that everybody should fit.

Everybody is a little bit different. And depending on your body shape, if you got a smaller waist or bigger hips, or if you are pretty straight, or whatever your shape is, there are small variations with everybody. But I think the general rule to follow is that you should be pretty vertical in your low back. If you start to curve too much, then your spine starts to bend in the middle of your low back. And if you think of a spring, if you bend the spring, it wants to come back to its straight up and down position. But if you hold it in a bent position, and then you make it absorb forces, it's only a matter of time before that metal spring begins to crack or break or not work properly.

If your spine stays bent too much, what tends to give out first is a disc. The disc can take a long time to get injured, but you'll begin to see a disc bulge or herniation. Over time, you can get degenerative disc disease, and it can be painful. But that's how disc injuries are set up.

Now, treating disc injuries is a whole different ballgame. We have to figure out what the source of the problem is. Is it truly just as muscle imbalance or other things? Is there weight to account for? If it's a female, have they been pregnant? How many times if you had a C-section? Because you are pregnant, they probably did cut open your abs and you probably lost strength to your abdominals, which is one of those stabilizing muscle groups.

Now I've got to ask the question, did you ever get that strength back in your spine, if it's curved? If it's too curved, what is too curved?

That's hard to determine. Even in the medical field, we don't know. We have people looking at x-rays, and actually measuring angles and everything. It varies from individual to individual because there are so many things to look at.

What will feel like if you have a disc herniation? It tends to feel like an achyness in the lower back, it can also set off muscle spasms. A true disc problem tends to generate pain right in the middle of the back, but you can have spots of pain that appear in different areas. It might change from side to side. Sometimes the glutes can feel painful as well. You might even have pain that runs down your leg. Because sciatica is a very common side effect of a herniated disc problem.

There are different versions of nerve pain that run down your leg Sciatica is one, there is another one called lumbar nerve ridiculous apathy. That's when you have a pressure from one of those discs that's pushing on a nerve, and it sends pain down into the leg. It could go all the way to your foot.

I've felt a mild sensation of that, and I remember feeling it down into my right big toe. It was painful. It was insane. So I felt it myself. But I've had plenty of patients coming in that describe the exact pathway of the nerve that's involved. We can usually trace it back to a loose disc in their spine because it's injured.

I just mentioned those words loose disc in the spine. Whenever I'm checking a client that has a potential disc problem. I actually look at the stability of every single level of their spine. This is important because what we should find is that it's uniform that pretty much every level of the lumbar spine of the lower back moves about the same. There are small variations. But there is a general normal amount of motion that each one should have.

What I tend to find in these people, that have very arched backs, they have some sort of history of a disc problem is that where their back hurts the most. The disc between the bones and in that level of the spine, tend to be loose in the bones that attached to the disc, and will move excessively. They'll move way too much, and if I poke in that area that people will typically say, Yep, you found the spot. That's it. That's where my back hurts all the time. It just doesn't feel very good for me to poke on there. But that's what I've got to do to figure out the problem.

Other signs that people tell us is standing for too long, doesn't feel good. They feel like they need to sit down to get relief. They will lean on things, lean on shopping carts, lean on tables or countertops to take pressure off their back. They are doing that subconsciously, they don't know they are taking pressure off their back always. But it will just feel good to lean out over this way. It takes pressure off their disk.

Another telltale sign of a disk problem is people that have trouble sleeping at night because of this back pain. They usually dread turning over in bed, if they go to twist and turn over to lay from one side to the other side or move on to their back or their tummy. It tends to kill them quite a bit. That's a more extreme example. But you do see that general twisting motions tend to not feel good. People who have children, for example, getting kids in and out of their car seats can be painful for them. Doing laundry, having to twist in awkward positions to get into a washing machine, or a dish washing machine as well.

That tends to be pretty uncomfortable on a back problem. They tend to not be able to stay bent over for any period of time. They usually are decently flexible, they can reach their legs or toes, even sometimes they even reach the floor. They don't tend to have a big flexibility problem. They may not be the most flexible person in the world either, but they don't report that they are inflexible. They have pain though, if they are staying in a bent over position for a long time, or if they are having to lean over and hold it for a while.

Some of these people tend to feel better when they lie on their stomach. It relieves your back problem versus lying on their back. They don't like it too much, especially when their legs are straight. They feel like they are very uncomfortable. When they lay on their back and their legs are straight, they have to bend them up, and bend their knees so that they can take pressure off their back.

Notice I keep saying take pressure off the back. That's really what is causing the problem, there is excessive pressure because the spine is bent and it's aggravating the disc problem. So if you get that excessive rotation that happens in the spine because it loosens if you are bent too far, and you walk like that, you live like that, you move like that, you start to rotate too much at that level of the spine, wherever the disc injury is at and it creates an instability at that disc over time. That's typically what sets up people for a bulge, or herniation. Or some people don't get that, they get degeneration over time.

Now, a big question that people frequently ask, whenever they come in for help with a disc problem is, can my disc heal? It's very confusing out there. And what I want to tell you is there is some research out there that shows that disc tissue can heal. There is no research out there that I've found conclusively that says that discs don't heal. What the research does say is that people with disc problems tend to not improve their discs. But that doesn't mean that there isn’t something out there that can make them heal.

There is evidence of discs healing, so I hope that's not too confusing. Just to say this one more time, there is no research that shows a disc can't heal, but there is research that disc can heal. And there is research that people that tend to have a disc problem basically tend to not do the right things to get better. So there is evidence that people don't get better is what it is.

Now, on the topic of disc healing, what we know is that it takes about a year for discs to heal, and it is possible to put scar tissue down in a injured disc area. As long as the disc isn’t injured so severely that it's pushing on a nerve, it tends to get better without surgery.

If you think that you have this problem where its pushing on nerve because it's so painful. That might be the case but in people that that actually need surgery, the pain will be debilitating. I mean to the point where they cannot move, they cannot function. In very extreme cases, they are having accidents like a bowel and bladder accidents, like they are pooping and peeing themselves. I have seen a couple of those cases and they don't look very dramatic. What they tend to say is I've made it to the bathroom, but it's real close. There has been sometimes where I actually get myself a bit dirty. But I usually am able to hold it longer and get to the bathroom just fine.

If that's happening, if you have those kinds of symptoms, if you got debilitating pain down your leg, you need to go to the doctor and get a MRI, likely they'll tell you what to do, you actually might need a surgery. But if it's just back pain, and I say just back pain, it could be very painful back pain, but you are not having any bladder problems, or having debilitating pain that doesn't let you even stand up or walk. It could still be limiting you from sleeping enough at night. It may not let you be comfortable when you are driving, you may find that you need pain medication and extra help from the doctor. Those types of back situations almost always can get better without having to have a surgery.

Now, let's talk about what the treatment options are for a disc problem.

The most common place that people start, whenever they visit their doctor for a disc problem is, they get offered pain medications. This could be muscle relaxers, it might be strong heavy-duty pain medications, or the doctor might even recommend over the counter pain medications. And many times, that's enough to take the edge off so that people can function, work, take care of their family and kids, and get them through a flare up.

But if this back problem isn't handled properly so that it's getting better for the long term, it's usually just a matter of time before it flares up again. You have to make sure that you take the proper steps to manage this problem for the long term.

Other things that doctors will recommend are back support braces, they sell them at a drugstore, and sometimes even grocery stores have them, or you can get them online. There are special ones that you can cinch down real tight. Those tend to be pretty helpful for disc problems, but they are short sighted, they don't fix the problem for the long term. You have got to fix that muscle imbalance.

Usually there is some weakness within the muscle groups that stabilize the spine. There might be some movement problem as well. There is usually a slew of problems that all come together to create a disc problem. But wearing a back brace might allow you to not take as much pain medication.

The next thing doctors will often offer are injections for your back. They will inject corticosteroid pain medications, pain medication and an anti-inflammatory medication straight into your back so that you can have less pain and they are pretty effective. Most people report having immense pain relief for up to a few months. The thing is, they don't last forever, some people will flare down and they get a longer benefit of pain relief. They might be good for six months or a year, but we often hear the story where people say, yeah, I've had this back problem for almost 10 years now. I usually can rest it off, I usually can do some stretches, I usually can go to the doctor. If it's really bad. They'll give me an injection and then I'm good for another six months, or another year and then it just keeps happening over and over as the years go by.

They keep self-managing with injections, with pain medication, and with exercise that stretches those kinds of things. But meanwhile, their muscles aren't getting more in balance, they are actually getting worse. And they are working on a disc injury, on a herniated disc, or a bulging disc, or they are creating degenerative disc disease in their spine. It's just a matter of time before it starts to really be bad to the point where it can be debilitating. You have to be careful with those injections as well. Use them as short-term pain relief, but make sure you work on a plan for the long term.

There are a couple of different surgeries that are commonly done. There are more than these two that I'm going to mention, but these two are the most common. The first one is what's called discectomy. This is the minimally invasive surgery that's done out there. And the reason why they say that is because they just make one or two small incisions, and you actually leave the office the same day. You don't have to stay overnight, usually in the hospital, and they can sometimes put a Band-Aid over the incision and that's all you need to heal from the incision site. That's why they call it minimally invasive.

But they do go all the way down deep into your spine right where the disc is at. And they cut off the chunk that's bulging, or they shave it down, or they remove the part that's herniated in the clean up your disk so that it's more normal shaped. They are taking out disk tissue.

If you have that really severe pain that's going down your leg and you are having tons of trouble, it might be what you need. But you got to be careful in thinking that this is going to be the last time you are going to deal with this back problem. Because if you haven't worked on your muscles, your strength, the way that you move, fix the underlying root problem for your back, then it's likely going to come back. We often see people that have had multiple discectomies.

I had a client in fact, who already had two and was on his way to have in his third. His surgeon was recommending a third discectomy in his back. But he didn't want to do that again, because obviously the first two hadn't worked. All this is within a year and a half timeframe from when he had his first one. He came to me to try doing an alternative physical therapy. And he had done physical therapy as well. But he had done a type of physical therapy that had a different kind of focus than what we have here.

Here at our clinic, we figured out his muscle imbalance, we figured out what joints were stiff, which ones needed to be stabilized, went through the whole process. And by the end of his treatment plan, which we saw him for about four months. He actually was weightlifting. With a barbell, one of those big long weight bars. With 135 pounds on his back, we loaded up his spine. And the reason why we got to that point was a cool thing that happens in discs in your back and really all tissues in the body as they adapt to forces.

We got this guy to the point where his back was no longer flared up. He was saying, I don't have any pain, I feel fantastic. I can bend over, I can stand, I can walk, I can even jog a little bit. We really tested him before we put any weight on him, and he's a big guy. He used to play football. He's has a pretty big frame. So he's able to take some weightlifting just fine. You could tell his body is built for it. We put a little bit of weight on his body and we had him do some squats with like 10 pounds, and then 20 pounds, and we worked his way up gradually. He sped through it and I was making sure that he was safe and that no adverse reactions were happening.

We worked on this form and his technique, and he had corrected his muscle imbalance to the point where he could squat and load his spine so that his disks can feel that pressure and the cells inside the disks can detect it and tell each other to get stronger and denser so that they get healthier.

Just like your skin will get calluses, if you are weightlifting or doing yard work, or house work that makes your skin get calluses around your feet as well. People get calluses on their feet all the time. That's the skins response to extra forces that's put on it so that it protects itself and makes it so that it's safe to do that activity again, without tearing your skin. If you get callus, that's good, because you didn't break your skin or get a blister, it wasn't too much activity too fast, because that's what will break your skin. Obviously, it was a tolerable amount for the skin.

We do the same thing in the back if we if we load the spine. Once it's all healthy, in a way that's tolerable, little by little over time. You can work your way up to where you are actually creating a protective amount of strengthening through the disk, but you have to lift weights to do that.

I just want you to be careful if you are out there and you got a disc problem. Please don't jump straight into weightlifting, like the story that I told you, you have to take it a step at a time, get expert help, make sure you are working with somebody who knows what they are doing, how to fix these muscle imbalances that we are talking about.

Don't jump straight into it. I'd be careful to working with a personal trainer as well, just because depending on their background, there are some trainers out there that are pretty good at what they do, but they may not have a full understanding of all the anatomy and the physiology. and the way that all this stuff works together. Their version of a squat may not be what you need. So you got to make sure you find the right kind of help to get to what you want to do.

That's just one story. I've got tons of other stories of people with severe disc injuries that are doing just fine now, even lifting pretty heavyweights.

Now, with surgery, and we were talking about the discectomy, the second most common surgery, if discectomy is not an option, or they've already tried them, and they haven't worked. The next most common surgery is a spine fusion.

When they do this, there are different ways they do it. But the most common one is where they put rods and screws into the bones of the spine to maintain the space of the disk and offload the disc, but at the loss of being able to move at that spine, that's why they call it a fusion. So those bones are essentially fused together through the hardware that's installed and it no longer allows movement at that level of the spine. It preserves the nerves and allows the pain to go away.

It's a miracle surgery, it really can make a huge difference. When done for the right person. There are people that lose the ability to walk because of a spine problem. And once they get a fusion done, and they can walk again because the nerves had the pressure taken off and they are normal.

If it's that bad and you need a spinal fusion surgery, then of course, consult your doctor and let them make that determination. But there are natural ways to take pressure off your discs using your own body, and there are ways to maintain that over the long term. And as we discussed, with weightlifting you can make your discs more dense.

My advice to you is, if you are dealing with a suspected disc problem, get started on getting help early, don't let it go on forever, don't let it fester and get worse and worse and begin to affect other things. Because it will create a nightmare situation for you. You don't want to have multiple surgeries or any surgeries for that matter. You don't want to have to be getting injections all the time and relying on pain medications, having to rely on putting on a brace all the time. You don't want to be defined by your back problem. You don’t want to be that person that is always talking about how much their back is bothering them.

I'm sure you'd much rather enjoy your work, your family, your life and be able to do the things that you want without your back bothering you.

So lastly, the next most common treatment for back problems is physical therapy. There are different types of physical therapy. I just wanted to highlight what we do here in the clinic at El Paso Manual Physical Therapy. Our specialty is manual physical therapy.

What that means is by hand, we spend a lot of “hands on” time with every client. And because we are by hand, moving every bone in the spine and checking it to make sure that it's moving properly. We look at the soft tissue, in other words, the muscles, ligaments, tendons, nerves, that might be affecting the situation.

We take a holistic approach when we are looking at the entire body, not just low back. Because oftentimes there is a hip problem that's feeding into the back problem. There is an upper back problem that's creating more pressure in the lower back, and even down into the knees, the lower legs, ankle and feet, we need to look at that as well. When you talk about the way that you are walking, about the way that you are running, or doing any other activity, we need to go in depth, and make sure that we address you as a whole person so that your back problem can get better for the long term and stay better.

That way you have the most control over your back, you know what to do, you know how to keep it healthy. If it ever starts to flare up on you, you know exactly what you need to get back to doing.

Physical therapy is amazing for back problems. You just got to make sure you find the right physical therapist that fits your needs. And that might just take a chance or two. You have to try different people, different companies and see what you like the best. There are different types of physical therapy clinics out there. And by and large, most of them focus on helping people after surgery. So if you have had a knee replacement or a back fusion, like we talked about a discectomy. Like we talked about meniscectomy and your knee, that's another type of surgery similar to a discectomy.

Going to these clinics that handle a lot of cases after surgery is a great idea. But if you haven't had a surgery, then going to a clinic that tends to see more cases that have just had surgery might not be the best idea, because they are just not going to be best suited to help you out. You might look out and find somebody that's great. But more often than not, you might end up doing very similar exercises to the people that just had surgery because that's how their systems are. H

Here at El Paso Manual Physical Therapy, we rarely see any surgical cases. We tend to help people that are just looking to avoid surgery. They haven't had surgery recently in the past, or they might have, and they just don't want the second or third surgery. But we are looking at people without them having had a surgery, so we are trying to fix a problem from getting worse, to the point where they need injections, they need to be relying on pain medications, and need a surgery. So be sure to do your research when looking for the right kind of help.

Thanks for listening guys. I hope this was helpful for you. I hope you know all about disc problem now and you know the best information so that you can make the best decision about how to move forward in helping your discs heal for the long term. Have a wonderful day. Bye.

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Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh physical therapist and I'm the owner of El Paso Manual Physical Therapy. We are talking today about upper back pain. Just to be specific about where the upper back is, because it can be confusing for some people. I'm going to include the mid back, and upper back as one, because a lot of these problems are in the thoracic spine, which is what we call it in the medical field. Basically, the parts of your spine where ribs are.

That's what I'm going to consider as upper back problem. But this goes all the way up to the base of the neck. It includes the backside of the shoulders as well. Now, some of the common diagnosis, we are going to go into that, and then we'll talk about the treatment options.

I'm just going to give you a little disclaimer right now, a lot of these problems that I'm going to go over, that affect the upper back, aren't always similar. In other words, there are very different body parts that are affected, which makes the treatments very different. We aren’t going to go into too many details on the treatments, just because there is a big giant variety, and it would take a whole episode for each one probably. But it's going to give you an overview of the different types of common causes of back pain, upper back pain and the treatments that are out there for that.

So, let's get into it.

By far, one of the most common problems in the upper back is rib problems. About the ribs, you have 12 pairs of ribs, and the first pair is way up top above your collarbones. I'll show you exactly where it's at. If you take your right hand. If you can't use your right use your left and put it on your neck on the side of your neck, like right into your ear, put your palm on there, and slide it down to where your neck moves into your shoulder. Right above your collarbone, but where your neck ends, and your shoulder starts. That's about the location of the first rib.

A lot of people don't realize that they are that high. And then they go all the way down to just right above your lower back. So, you got tons of ribs, you got 24 ribs, if you think about it. Ribs have the ability to shift, so they can shift up or down, forward or back. When they shift, they tend to get stuck. There are muscles that attach to ribs, and there are of course joints where they meet the spine in the back. Then they wrap around to the front and meet the front part of your sternum, they attach through a bunch of cartilage.

Not all the ribs attach to the front, the last two pairs that’s the 11th and 12th pairs don't actually attach, those are floating ribs. What well if you've got upper back pain, and typically it's off to the side, it's off to one side of the right or the left. Many times, it will radiate, it will shoot from the back off into the side of your body, under your arm might even be in the armpit area. Sometimes it will create some tenderness in the chest. That more often than not, is a real problem.

Depending on how it’s shifted, you have to get the right kind of help to make sure that you shift it back in the right direction. It's critical, because think about it, if your ribs shifted forward, and somebody's trying to put pressure on your back, it's going to further shift the rib forward, because you are pushing it from back to front, it's already shifted from back to front. So, you got to know which direction to go in, how it feels, it's a science definitely, it's its own specialty, in figuring out the position that rib is stuck.

The most common way that ribs get stuck is backwards, where they pop out backwards from the spine. Pushing it in is definitely a common treatment. I can tell you from experience, I've had that happen before. It's not a comfortable experience to have a rib shifted into position. It's one of the few things here in the office that I have to tell people that disclaimer ahead of time and say hey, this time it's going to hurt, but you are going to feel a ton better after it's done. Most techniques don't hurt to get them done on people. One of those, the most common problem that you can have in your upper back is a rib problem. A rib that's shifted or stuck.

You can also have cracked ribs, you can have broken ribs, and that's related to an accident usually, like if you were in a car accident or some severe fall, those are not that common. Here in our office, they can't happen obviously out in normal life. But if you've had a history of a cracked or broken rib, more often than not, after the rib is healed, you might have a shifted rib. That could be causing some back pain. If you have that history of that happening in the in the past.

If you are all the way healed, then you are going to be ready to do some sort of treatment that shoves it back into place. If you have an actively broken rib or it's cracked, you do not want somebody pushing on it right now because you can make it worse.

The next most common thing that happens in upper back pain is shoulder blade problems. The cool things about the shoulder blade is, they are floating bones, they float in a bunch of muscles on your rib cage. Of course, on the outside corner of your shoulder blade is the socket for the ball and socket joint of your shoulder joint. These bones are really cool. There are over 20 muscles that attach and control the shoulder blade. And because there are so many muscles, it's quite easy to develop a muscle imbalance that makes the shoulder blades not operate normally.

If that's there for a long time, it can tension certain muscles too much and create a back problem. Now here in the clinic, we call that scapular dyskinesia, that just means bad movement of the shoulder blade. There are a bunch of different ways that it presents. Sometimes it's related to posture problems. Sometimes it's related to strength. Sometimes it's related to the sleeping positions. Most of the time, it's a combination of all those things.

But shoulder blades can cause problems and it's never the bone. It's always the muscles that attach to the bone. Unless you have had trauma, like I said, with ribs is huge, because it is possible to have a cracked shoulder blade or a fractured shoulder blade, which of course is going to change the way the muscles operate. So, take that into consideration.

If you've been in an accident, you might have back problems, upper back problems related to an old fracture and your shoulder blade. But to fix that, there are tons of options. It just varies. There is usually some sort of exercise, some sort of hands on work needed, to free up the joints of the shoulder blade. It has three main areas where there is, I guess you can call it four joints, where the shoulder blade moves. It attaches to the collarbone, and the collarbone itself will move the ball and socket joint on the outside, and then there's what's called the scapula thoracic joint. It's not a real joint but if there is movement that occurs between the scapula, the shoulder blade and the rib cage, it slides on itself.

Then on the front side, there's a ligament that connects it to the rib cage as well. So the shoulder blade can cause lots of problems.

The other less commonly found, upper back problem that I find in people is nerve problems. If you think about it, our body is covered in nerves, you just don't see it and it's not commonly talked about. But for people that are dealing with having to work at a desk job, having to be in the same position for a long period of time, having to be sedentary because that's what their life requires them to do at this time. Their nerves can get very aggravated in the back.

The way this typically presents is a burning sensation that runs up and down the upper back, an achyness as well. It may get worse if you go pick up something heavy because attentions and nerves more if you look down, in fact, to try this out, you can check yourself if you have got an upper back nerve problem. If you look down and bring your chin to your chest, like try to push your chin against your chest as much as possible. If that begins to set off that bad, achy feeling, that's likely a nerve problem. It could be muscles as well.

There are different ways to differentiate it. But that's a beginning of a common test that we do here in the office to start to figure out if you have a nerve problem, there is more that we have to do for you, but half the time there's a nerve problem. When you look all the way down and you feel pain going down your mid back area that is almost always a real problem. There is muscle imbalances that are associated with that. We have to look at the neck, we have to look at the lower back as well, the shoulder blade positions.

There is a lot involved in fixing nerve problems in the upper back. This pain that radiates down, this burning sensation, this discomfort, it can also be present in the neck. We have to look at the neck joints and muscle imbalances up there as well.

The next two problems that I'm going to cover, that are commonly found in the upper back area are less common, but they do happen, and they are related to each other.

I'm going to talk about thoracic disc problems. In the medical field, they usually talk about cervical disc problems, which is neck problems. In your neck you can herniate those discs, you can bolt those, you can get degeneration in those. Then in the lower back, in the lumbar spine, there are lumbar discs as well that can get injured. But it's rarely ever discussed the discs that are in the thoracic spine, in the middle and upper back part. But you can get problems in those discs as well.

It's hard to detect them on an MRI or X-ray. It's more commonly found by hand, by an expert like myself, like somebody who's pretty good with hands on, feeling the body, feeling the joints, feeling the muscles around there. Once it's found, it's really easy to clear up actually, we have helped people with disc problems in the thoracic spine for years now, and it's actually quite straightforward to clear up. It almost always clears up. I've never seen somebody that was debilitating.

It didn't get better, but it can feel like, and the common words that people use is, it feels like somebody's putting an icepick right into the middle of their mid back, right in the center. And I have to ask, is it off to the right, or off to the left? And they always say Nope, it's right in the middle. Then once I do my testing, and for the discs in the middle back, I'll find the spot and I'll poke a little bit. They'll say, Yep, you found it. That's it. That's the spot that hurts. And I can tell that it's a disc problem based on how stable that section is.

Because whenever there is a disc injury, the vertebrae, the bones in that area aren't moving as good and they get loose. That's how I can feel all those little changes in the spine. Associated with this, with these disc injuries, is something called T4 syndrome. You can Google this it's a thing.

T4 syndrome is a loosening of a disc, they think it's at T45, but in my experience, I think it can be anywhere in the thoracic spine anywhere in the upper back and we are in the mid back. Because there are certain nerves that control a certain part of your nervous system, specifically the sympathetic nervous system, this is higher level stuff. You don't have to go look this up if it's confusing for you.

The sympathetic nervous system controls the fight or flight parts of the nervous system so it can regulate pain. There are all these details that we look at. But what you need to take away is that about t 45. That part of the sympathetic nervous system affects the arms. In people that have this T4 syndrome, they can sometimes get pain, numbness, tingling into their arm. And if it happens to be on the left side, and they also have a neck problem, a lot of times they think that they are having a heart attack, pain in the arm, pain in the neck on the left, especially a female because females tend to not live through heart attacks more so than men. It can freak them out.

We have had patients come in and say, I went to the hospital, I got my heart checked, I had all these checkups with a cardiologist, and they say, I'm fine. There's nothing wrong with my heart, thank God, but my arm still hurts, and I can't sleep at night and my back's killing me and my necks killing me. When we check them out, thankfully they've already cleared out all their heart stuff, so we don't have to send them to the doctor to do that. But then we find that loose disc in their spine and we diagnosed them with T4 syndrome. The good news like with other thoracic disc problems is that it heals just fine as long as you put in the right environment.

Since it is a disc, it can take up to a year to fully scar down and not cause problems constantly. But within the first few months, you can see a dramatic reduction in pain and be able to sleep comfortably, sit comfortably, move your arms and exercise as well.

Some people have trouble exercising because of this. For most people though, when they have been sitting for a while, is when they feel the most. They get that sensation that feels like an icepick into their back. This part of the back, just talking about treatment, because oftentimes, people go to a chiropractor and get their back popped, or they get their relatives to pop their back, they'll just do come up from behind and give them a bear hug and pop their back. That can be quite relieving for people that have stuck joints in their back and it will move some of the ribs that are stuck as well.

But in people that have a thoracic disc problem, you got to be very careful about doing any sort of those techniques. I wouldn't have your spouse do it or your relative do it. You got to make sure that it's done by a professional. I've had a few conversations with chiropractors here and there and I've never heard them know much about T4 syndrome whenever I bring it up. I can't say that I have a good sample of chiropractors that I've asked about it. But the ones that I have, just haven't talked too much about it. I don't think that they are aware of thoracic disc problems.

They have had the experience where clients come in and say, Well, I thought I needed to pop my back because I had that icepick sensation where it felt like stabbing. I went to the chiropractor and they couldn't pop it. They did their thing and it popped a little or didn't even pop at all, but actually left me feeling worse.

I think that that happens because they are overstretching an already loose thoracic disk and unknowingly, they may not know how to check for it and how to handle that kind of situation. They go through their techniques and it might be injury. If you think that you have a thoracic disc problem, if you think that you might have T4 syndrome, I just want to let you know to exercise caution with, letting anybody pop your back.

We do those kinds of techniques here in the office, we do thoracic manipulations. That's where we can create some pops in the back joints if needed. And we do it very judiciously, very carefully. And not everybody gets it, it depends on if you need it or not, and if you are comfortable with it, but for a T4 syndrome or thoracic dis syndrome, we are definitely staying away from those areas that are affected. Because we do not want to contribute to making that worse, we want to make it better.

But in order to make it better, we might need to work on some other spots nearby to make sure that that T4 area, or any of the areas that are affected are safe and getting better.

Now let's talk about some of the treatment options. We already went over thoracic manipulations and adjustments a bit. But let's discuss braces. I've seen some people get really, really into fixing their posture. And I think that's great. You should have improved posture. But some people go so far as to wearing braces that hold their shoulders back and make them sit up a little bit.

There are braces that you can find out there that are special for posture. I've even seen some clients that have a device that they can attach to themselves under their clothes, and it buzzes them a little bit, it vibrates. I haven't seen anybody have the one that shocks you, but there's one out there that actually can shock you a little bit. Where if you lean too far forward, and you start slouching, these devices let you notice it to back up and straighten up your posture.

That's definitely something that can help you out. Posture isn't always the solution, though. And some people overdo it with posture. There are actually cases where I have to tell people, you are sitting up too much, you are overdoing your posture and you actually need to slouch a bit because you are going to hurt your back, and that might be contributing to your upper back problem.

People will also go do certain exercises and stretches and there are so many muscles in the upper back and in the shoulders and neck, that it's hard to tell you exactly what exercises are best for you. The best advice I can give you is that if you are out there doing exercises for your upper back, and they are helping you great. Awesome! Sounds like it's probably going to be a good thing for you to keep going with that.

But if you are doing an exercise and it's making no difference, or it's making you worse, you definitely want to back off from those exercises so that you are not creating a bigger problem for yourself. That's going to take more time and effort and money to fix down the road.

Pain medications are often used, we I often hear people with upper back problems like to take over the counter pain medication. Stuff like Ibuprofen, Naproxen, Tylenol, those types of over the counter medications. Some people will go to the doctor and get prescription strength medications, they'll get steroids type of medications that are anti-inflammatory and pain relieving. They will get some muscle relaxers as well.

I have seen some people get injections into their spine for upper back problems and lower neck problems. Those tend to be pretty effective. But they just have short term benefits. It is still pain medication, but it's just injected into the painful area. It's not creating more joint motion or strengthening the muscles. It's not fixing your posture. There are other factors that need to be considered to make sure that this problem gets better for the long term.

Surgery is rarely done. I haven't really seen anybody get an upper back surgery. I can tell you I've never seen anybody get an upper back surgery. What I tend to see is, people getting shoulder surgeries because they start to have shoulder problems, if an upper back problem has been there long enough.

I've seen people getting neck surgeries for sure. They do neck fusions and discectomy and other things in the neck. That could be contributing from the neck problem as well. Now, something that I haven't mentioned yet that's important, I think, is something called a downward hump.

A downwards hump is the bump that people get on their upper back at the base of their neck. That bump is where the spine is bending forward. And it's stuck there because the joints are stuck, or it might be stuck because the person isn't strong enough to straighten up. But we often see that as a telltale sign that there's going to be some neck problems, there's going to be some upper back problems, and there's likely going to be some nerve and shoulder problems as well.

If you are listening to this podcast right now and you are thinking I might have some of these problems that he's been talking about, and I just put my hand on my neck and my lower neck, upper back and I feel that I've got a little bit of a bump going. Plus, my parents had that bump or one of my parents had the bump, I might be genetically predisposed.

I would urge you to work on fixing that bump as best as you can. Whether it takes some professional help, like you hire somebody like us at El Paso Manual Physical Therapy, or you go and do some stuff on your own. Any way you slice it, having that bump is not a good thing. It's going to set you up for all these problems that I talked about, shoulder blade problems, nerve problems, related problems, the first and second ribs are frequently affected with that bump. The discs above and below that bump can often get affected as well.

Even though the bump might not be painful, most of the time it is very tender, and painful. Plus, it's unsightly. I often see women that have it, they don't like to wear their hair up because the bump is exposed. They wear their hair down to hide it and they try to work on their posture but just can't quite seem to get it. There are many different reasons why the bump is there and there are many different ways to fix it, you have to find the best way to fix it.

But I would make it a pursuit to make that bump go away for your health. I'm sure you'll love the aesthetics benefit of it anyway, where the bump is no longer there. But have to fix it for your health.

If that bump has been there long enough, if you are older and you've had it for decades, what can happen is the joints in that area can become really stuck. We call it our thrust or fused and it won't get better. It won't really straighten out. And you see some people that are stuck in that position. They need a lot of pillows to get comfortable and their back. They are hunched over, and they have to look up at you and they get shorter.

There are all kinds of side effects to that. So, you don't want to live with that. You want to make sure you take care of it while you are younger. Here in the clinic, we check if there is any potential for the mobility to improve in those joints. We check the muscles that support the spine in that area. We look at the bones above and below there, to see if they effect in any way the muscles that run down from the back into the shoulders. And if we find that bump in somebody who's got a shoulder problem or another upper back problem, you bet we make a big deal out of it because they need to fix it.

For that bump I've never seen a surgery for it. I've seen people get it injected. I see people taking pain medications for it and people trying to work on their posture to get a better but sometimes there are specific treatments that need to happen.

Oftentimes here in the clinic, we help people fix problems like these upper back problems, the bump, the T4 syndrome, thoracic disc problems, nerve issues, problems with their shoulder blades and the rib issues. We help them address those problems without relying on pain medication, injections and surgeries. Usually an option for a lot of these things. We help them because there's no other option and they tend to get better where all these issues improve tremendously, as long as they are not too far gone.

People can generally get better sleep at night. Remove the unsightly bump, to get rid of the achyness and burning, they are having running down their back. That sharp, deep pain. They can come out with a disc issue or a shifted rib that just doesn't let you breathe right, and the pain radiates from the back to the front. That is very correctable.

I hope that this podcast was helpful in increasing your knowledge in upper back problems. I hope that you feel much better prepared in making a decision about how to treat your back problem. Know where to go, what to do, how to approach it, how to think about it even. Because some people may or may not be that bad, you may not need to do anything about it right now. But if it's been going on for a while, then you need to start thinking about how you are going to fix this for the long term.

If you are interested in hiring us to help you with this problem, it's really easy. The best place to start is calling us at 915-503-1314. And if you know of anybody else that probably needs to hear this podcast, please share it with them. Let them know about the tips that we have in here and to listen to it. Have the best day ever. Bye.

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