Different type of therapy

[momof5]

I'm not sure if I should type this in here, or find a different spot.

I need some streach exercises for shoulders, hips and total back.

Begining of december I slipped on ice, not falling, but doing a sort of whiplash motion that increased pain levels greatly. By the end of the day I can hardly stand due to the pain.

Meds taken right now. 20 mg of oxy, 10 mg of vallium in the morning, 1-2 percacets every 6 hours, then the same dosage of oxy and vallium at night. I'm still in pain.

I have an appt on the 4th, and have been trying to cut down on the meds so that the true pain is there.

So that brings me to streach exercises that I need to do, but am not sure of any. It has been a while since I have been in therapy and most of them have slipped my mind, as well as they were water exercises.

I'm also afraid the exercises will increase the pain.

Any guidance or help would be so greatly appreciated.

 

[Daniel E.]

I don't know what your appointment is for on the 4th of January. Of course, I would think going back to seeing a physical therapist would be ideal. The water exercises you used to do sound ideal, too.

Generally speaking, for back pain, some stretches that come to mind:

- walking
- McKenzie exercises
- knee-to-chest stretches
- hamstring stretches

For shoulders, back, and hip stretches that can be done at home or at work, the Mayo Clinic has some online videos, e.g.:

Video: Shoulder stretches and upper back stretches for the office - MayoClinic.com

 

[momof5]

Thanks Daniel, the next appt is to see if the pain is still as persistant as it is right now. I can't see it changing by then.

Unfortunatly, though I have insurance, our copay on therapy would be expensive per week. It would be cheaper for the dr to give me some to do in the water and pay 5.oo per visit at our local gym with the pool.

I know I should have started the streaches sooner, but just to stand and walk causes immense pain. With son and his wife coming in for christmas from california, well, I just did not have time to rest it as the dr wanted me to do so. I dont' know when we will all be together again.

I still have New Years dinner to play for NY day.

I'm going to check out the things that you have above. I'm trying to down the amounts of pain meds, however, every time I do, the pain escelates. He fears that I have caused more damage to the original injurie areas. Knee refelxes aren't where they should be.

Needless to say, after a year of battling other health issues and now this, I'm a bit down and aggitated.

 

[Daniel E.]

Regarding the McKenzie method, I just read that it is contraindicated for some conditions:

..developed by McKenzie to allow the discs of the spine to shift away from the nerve roots. However, this exercise also puts your spine in more extension and can exacerbate conditions like Facet Syndrome and Spondylolisthesis, where the spine is easily compressed in extension. Therefore this exercise should not be performed unless in these types of conditions unless expressly recommended by your doctor. You should feel no pain with this exercise, only a pulling up of the spine as the back goes into extension

Back Exercises

Even knee-to-chest exercises may cause problems for some people:

In general, extension exercises [like McKenzie] may cause further damage in people with spondylolysis, spondylolisthesis and facet joint dysfunction (Harvey 1991), not to mention the possibility of crushing the interspinous ligament (McGill 1998). While flexion exercises [like knee-to-chest?] should be avoided in persons with acute disc herniation (Harvey 1991).

http://www.backtrainer.com/Williams-Flexion-Versus-McKensie-Extension-Exercises-For-Low-Back-Pain.html

(My mother used McKenzie exercises for sciatica at one point but, for whatever reason, relies on other stretches now, like hamstring stretches and knee-to-chest stretches. On the positive side, she didn't experience any problems with the McKenzie exercises and may have gotten some temporary benefit.)

 

[momof5]

Hi Daniel,

I don't have the spondylolysis, spondylolisthesis , however, I do have 9 herinated and buldging dics from the lumbar to thoracic levels with one disc at the t8-9 area in very slight contact with the cord.

I would imagne that some of the more mild ones would be ok? I have copied them into word so that I am able to print this out.

Thank you for the additional information, I do appreciate it.

 

[Daniel E.]

I would imagne that some of the more mild ones would be ok?

Could you call your doctor on Monday?

Personally, I'm not familiar with multiple herniated discs. Certainly, the exercises I have mentioned are very safe when there isn't a pre-existing injury and have helped some people with back pain who have a chronically herniated disc. My mother was able to due them without any resulting problems, but she only had one herniated disc. When I have done the exercises, they seemed pretty mild to me, but I don't have any pre-existing injuries. Some exercises to avoid:

Potentially harmful exercises include bouncing
while stretching, standing toe-touches, full
squats, straight-legged sit-ups and double leg
raises.

http://www.goforyourlife.vic.gov.au/hav/admin.nsf/images/Exercises_that_could_be_harmful.pdf/$File/Exercises_that_could_be_harmful.pdf

Unfortunatly, though I have insurance, our copay on therapy would be expensive per week. It would be cheaper for the dr to give me some to do in the water and pay 5.oo per visit at our local gym with the pool.

If the doctor isn't as helpful as you would like, I would think a compromise which you may have already considered is going to one or two physical therapy appointments to get recommendations of which exercises are best for your current condition and to get handouts of the exercises. Regarding the water therapy, another possible cheap alternative:

I always like to suggest the People with Arthritis Can Exercise (PACE) programs. These can commonly be tailored to people with back pain, especially their water program. Usually there's a certified PACE instructor at the local YMCA or Jewish community center. These programs can become a lifelong program for patients, where they can go twice a week and exercise for an hour in the pool. And usually, those exercises are the same kinds of things we try.

NPR : Q & A: Physical Therapy and Back Pain

 

[Daniel E.]

Also, at least pertaining to the future, a good reminder is:

Q: How do we prevent back pain? How do we strengthen our backs?


A: The best thing is to keep your back healthy. Staying in good aerobic condition with good cardiovascular function is really one of the best things you can do for your back. A variety of activities can help with this, from a brisk walk to jogging. Yoga and stretching also can help. Remember, hurt does not mean harm; just because your back hurts doesn't mean you are going to harm yourself when you stay active.

This doesn't mean that you won't have back pain if you exercise. But it does mean your muscles will be in better shape and you will get better faster.

NPR : Q & A: Surgery and Back Pain

Of course, with stretching exercises, the advice I read is to stop if a stretch causes pain, but the quote above pertains to physical activities like walking.

Anyway, the water exercises you are planning on doing seem to be the perfect transition exercise since they are less painful. The arthritis foundation has a free brochure that they mail out which includes some water exercises. The top hits at Google also have some good results, including how to do knee-to-chest exercises in the water:

water exercises back - Google Search

A book on water exercises also includes an illustration of doing the knee-to-chest exercise in the water on page 37:

Water Exercise - Google Book Search

The above book seems to state that doing the knee-to-chest exercise in the water is much safer:

This is an excellent lower back and hip stretch. By performing this move in chest-high or slightly lower water, the load or pressure on the vertebrae and discs of the spine is reduced about 70 percent.

However, since the knee-to-chest exercise can be done lying down on a bed, I don't know how much additional safety benefit there is doing it in the water since one would be standing up, with standing putting more pressure on the back than lying down.

(The book states that the knee-to-chest stretch is an excellent lower back stretch, but it can cause problems if one has had hip surgery.)

A book you may also find relevant:

Amazon.com: Water Exercises for Fibromyalgia: The Gentle Way to Relax And Reduce Pain: Books: Ann A. Rosenstein

Yet another water exercise book, possibly the best one since it's aimed at back problems specifically:

Amazon.com: BackHab - The Water Way to Mobility and Pain Free Living: Books: Ruth Sova

Also, the site below sells some DVDs on water exercises:
Aquatic Exercise Association

For example:

BackHab II DVD
(I assume this is a like a DVD version of the book by the same name)