Facet Joint Back Pain

I treat a lot of people with back pain. The hard part about treating patients with back pain is getting the work we do on the table, to translate to standing and walking. Patients who are older (I’m talking 35+) will usually have pain due to a facet issue, degeneration in the back, or both. Lying down is a great position for those issues because it doesn’t put pressure on the back. Once you stand up, the back compresses, puts pressure on the joints, and the pain returns. If this sounds like you, let me give you a simple solution to provide you with some relief for your back pain with standing.

What’s a Facet Joint?

Unless you went to PT school, or some form of medical school, you have no clue what a facet is or what degeneration looks like in your back. Well...that is what I’m here for. Let me school you on some anatomy. Facet joints are the joints of the spine. Just like any other joint in the body, the spine moves. It requires joints to allow that to happen. In your spine you have facet joints on each side of every vertebrae from your head to your hips.

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Like all your other joints, the facet joint can get inflamed. When you compress an inflamed joint, it hurts. Facet joints get compressed when you are standing and when you extend. Hence the reason why lying down feels better, and standing hurts.

What do I do for Standing?

Since most of us can’t lie around all day, what do we do when we’re standing to help alleviate back pain? The key to having less pain with standing is understanding the position of your pelvis. Most of us have what is called an anterior tilt at our pelvis. That means that the front of our pelvis sits lower than the back part of our pelvis.

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Speaking in generalities, this usually happens because our hip flexors are tight and our abdominals are weak. In the game of tug-of-war, a tight muscle always beats a weak muscle. In therapy we will try to stretch the hip flexors, and strengthen the abdominals to correct the imbalance. That doesn’t always carry over to a standing position though. Sometimes, you have learned to stand like that so you need to retrain the brain to stand in a neutral pelvis. What is the best way to do that? Train your hips in a standing position. Here is a simple exercise that I like to give my patients that have back pain with standing.

Give this a try to help alleviate your back pain with standing. You can perform as many of these as you want. The exercise is meant to help you retrain your brains standing pattern. There is no resistance involved so you don’t have to worry about overdoing it.

I hope this helps correct your back pain you are getting with standing. If you have any questions please contact us. If you want a free session to review how to perform the exercise properly just mention this post and OrthoCore will give you a free 15 min session at any of our clinics. Thank you for reading!







Knee Arthritis vs. Meniscus Tear

I’ve had a lot of patients throughout the years with knee pain (I know, earth shattering beginning to a blog post). The biggest thing that we do as Physical Therapists is figure out what is the cause of your pain. I feel like I’ve had a group of patients recently, that have knee pain and their MRI shows they have a meniscus tear…and arthritis. The problem with having both is it makes it hard to discern where the pain is coming from because they are so closely related. The other problem with having both is that surgeons are usually shy about performing a meniscectomy (remove the torn meniscus) because it may not relieve your pain symptoms. That being said, let’s talk about the differences between the two so you can make an educated decision if this is what you are dealing with.

What is a Meniscus Tear?

The meniscus is the shock absorber of your knee. You have one on the inside (medial) and outside (lateral) of your knee. If you were looking down from the top of your knee they look like two lima beans. If you look at them from a straight on view they look like a race car track meaning the peripheral portions are thicker and it slopes down towards the middle of the knee from there.

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Typically a torn meniscus will hurt right over the joint line and will be sore at end ranges of knee movement. It will also usually hurt with activity, especially loading and twisting. Remember, its your shock absorber, so the more bumps you take the more strain you are putting on it. Think of it like driving a car. If you go over a lot of bumps you will feel it more.

When you have a torn meniscus the surgeon will usually just cut out the torn portion, which is usually on the inner portion. That way they can take the torn tissue, while still leaving a lot of meniscus for you to play with.

Recovery is usually quick (if you have a good PT) and you are usually back to your normal activities in a couple months time.

What is Knee Arthritis?

Arthritis is a loss of cartilage. Cartilage is like the shiny end of a chicken bone. When cartilage slides on cartilage, no problem, when it starts to wear down is when bone gets exposed and can lead to inflammation and pain.

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Arthritis is usually worse in the morning and at night. During the day, if you keep your knee moving without much impact, it usually makes the joint feel better. Activities like biking, swimming, non-impact weight lifting are good.

Arthritic pain is usually more global, meaning it’s hard to pinpoint with your finger. Sometimes it hurts in one area. The next day it could hurt in a completely different area. It depends on how much arthritis you have and what types of activities you are doing.

The surgical solution for arthritis is a knee replacement which isn’t as easy to recover from as a meniscectomy obviously. Recovery from a knee replacement is 3-6 months (back to activity with some pain) with full recovery usually by a year.

How do I know what to do?

So what do you do if you go see a doctor only to find out that you have a meniscus tear AND knee arthritis? The best thing to do is start to write down where you have pain in your knee and when. If you start to see that it is more over the joint line, and more with jumping/twisting activities, it’s probably coming from your meniscus. If you find that it is more painful in the morning, but gets better as the day goes along, and not in a consistent spot, it’s probably arthritis.

I would always recommend trying a course of PT first. In both cases there have been plenty of studies that show that PT can be effective without requiring surgical intervention. If PT doesn’t help and it appears to be more meniscus, if it were my knee, I would have the surgery. If PT doesn’t help and it appears to be more arthritis, it depends on what I would recommend. A knee replacement is a much bigger surgery, but is also really effective for relieving knee pain. It is really age related but I will say this … most patients that I have, that have had knee replacement surgery, say they wish they had done it sooner.

I hope this helps to give you an idea of why your knee hurts and what you can do about it. If you have any questions please comment below. If you would like to schedule an evaluation to see what might be causing your knee pain, please contact us at OrthoCore Physical Therapy  401-667-0131 to make an appointment at our Westerly or North Kingstown locations.




Running with Knee and Back Pain

So, I’ve been running more lately. To anyone reading this that knows me, knows that comes as an enormous surprise. I used to be a huge runner (3-4 times/wk) but, running and I fell out of love when I started to get injured. My knees and my back were always bothering me. I was getting tired of showing up to work and feeling worse off than my patients. Instead of working on the flexibility and strength deficits that I had, I decided to just stop running. Not exactly what I would recommend to any of my patients but, effective at eliminating my pain nonetheless.

Well I’m back on the team! I credit my return to three things. 1. Like most other people who run, it’s easy to just get out of the house and run. It doesn’t require driving anywhere, or signing up with any gyms, etc to participate. 2. I can do it with my kids in a stroller. I get to spend more time with them, and it gives my wife a little break (double bonus). 3. I was intrigued when I saw that “Headspace” had a running packet. To those of you who don’t know, Headspace is a meditation app. I’ve been using it for a while now and the running specific pack piqued my interest. I was pleasantly surprised it actually made it really enjoyable to run. It didn’t feel like the mental struggle that I remember from the past.

Unfortunately, with my renewed love of running, my knee and back pain returned as well. It’s like when you get back together with an old girlfriend and realize part of the reason why you broke up was her annoying best friend. Well this time the friend isn’t going to break us up again. Instead of running from my problems (see what I did there), I’m going to address them and make sure that I can keep my feet on the road.

My main issue (as is the case with many runners) is that I have very tight hip flexors and IT bands. Those muscles run in the front of the hip and can restrict your hip extension and stride length.

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The problem with the hip flexors, and the reason why I get back pain, is that they anchor at the lumbar spine. When they are tight, your spine will flex with every stride and put excess pressure on your spine causing pain. The IT Bands run all the way down to your knee. When they are tight they will pull your knee out of alignment. That misalignment with every step will eventually lead to pain. Hence, the reason why I get knee and back pain when I run.

The good news for me (and anyone reading this with similar problems) is that it’s really easy to fix. All I have to do is stretch those muscles regularly to keep my body aligned and moving properly. Here is my favorite hip flexor and IT band stretch. If you are stretching pre-run then perform 15 repetitions holding the stretch for just a couple of seconds. If you are stretching post-run then hold for 30 seconds to a minute and perform the stretch a couple of times.

I hope this helps you stay flexible and keeps your feet on the pavement. If you have any questions please contact me here at OrthoCore Physical Therapy. Otherwise, HAPPY RUNNING!

Foot Pain Due to Flat Feet

I know this comes as no surprise but I’ve been treating a lot of feet lately. Apparently when you open a second office with a Podiatrist that is bound to happen. A majority of feet problems that I see are due to flat feet. About 12% of the population have flat feet. That might not seem like a lot but when you consider the amount of people in the world, that’s a lot of fallen arches.

Most foot problems, that are due to flat feet, stem from weakness in the arches of the feet. There are a group of 9 small muscles in the foot that help to create and maintain the shape of the arch.

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Just like any other muscle in the body, if you don’t use it you lose it. The hard part about people with flat feet is that the muscles are constantly on stretch. A muscles that is constantly stretched, is going to be weak. So you are really fighting an uphill battle. The other difficult part for most people is they don’t know how to strengthen their feet. What do you do? Put a tiny dumbbell around your toes and do curls? As much as I would love to see people try that, it wouldn’t be effective. Here is one of my favorite exercises to do to strengthen the intrinsic muscles of the foot (crazy socks not required, but recommended).

If you perform this exercise regularly it will help to strengthen the foot muscles and start to build up your arch. If you have a really flat foot, I also recommend wearing a foot orthotic to give a little extra support and bring the arch up to where it belongs.

I hope this helps to keep your piggies from aching and get you up and on those feet pain free. If you have any questions please contact us . Thanks for reading!