Archive for the ‘back pain’ Category

When is a tight hamstring not a tight hamstring?

Friday, October 15th, 2010

I saw a patient today who presented with complaints of a tight hamstring. Further investigation revealed that he had bilateral pain, and occasional peripheral pain below the knee in addition to the tight hamstring.

Immediately, my thoughts went to a central problem rather than the pain in the hamstring being caused by a hamstring issue.

Further testing revealed good hamstring length, good hamstring strength and a generally negative neurological exam.

Palpation suggested that his hamstring is normal.

So I asked him to go back to his doc and to ask for an MRI of his lumbar spine. The reason is that he has a central problem. How else could he develop bilateral pain even if it was and is worse on one side? Beyond that with no significant evidence of neurological involvement, and since his pain has been present for more than 5 years, the fact that it is worsening now made me ask him to go get an MRI. There is always the possibility that he is growing something, although it might just be a disc bulge that is causing bilateral pain. At Sports Reaction Center, we perform a complete evaluation including a functional screen and a neuro screen as well as what is known as a Cyriax evaluation designed to reveal the tissue in dysfunction.

So the moral of the story is that unless you can identify a specific insult to the hamstring, there is a good chance that that pain in your thigh originates more proximally.When in doubt get more data. A good PT or Physiatrist can help you sort out your issue.

Posted in Uncategorized, back pain, hamstring pain, pain in the leg | 7 Comments »

Lower Cross Syndrome

Saturday, July 3rd, 2010

In the Western world, it is very common for people to develop a “lower cross syndrome”. This is a mechanical circumstance where tight hamstrings, tight hip flexors, weak abdominals and a sway back conspire to cause lower back pain. In a culture that sits a lot, doesn’t exercise much and has a high incidence of lower back pain, it is common to find lower cross syndrome at the root of the symptoms.

The best “treatment” for this syndrome to to combine stretching of the hip flexors and hamstrings with strengthening of the abdominals, or core strengthening. The core program can be found in the LITE version of our app. The stretches are to be found in the full version of the app.

For long term back health, combining core strengthening with lower extremity flexibility is key. In our clinic, Sports Reaction Center in Bellevue, WA, we have successfully treated thousands of lower back patients over the years using these strategies. In the absence of disc herniation or other mechanical causes of lower back pain, this simple strategy can solve your problem.

Posted in Uncategorized, back pain, lower cross syndrome | 1 Comment »

Why Ice and not Heat?

Tuesday, June 15th, 2010

I am often asked the question about heat vs ice. First let me say that there is a lot of mythology about this question. My opinion is simply based on the science.In the clinic, I answer the question this way:

Heat works to reduce pain through a cutaneous (skin) reflex that is inhibitory to pain as long as the receptor is being stimulated.  The problem is that the receptor accommodates to the heat and so the heat source has to get hotter and hotter in order to inhibit pain.  One risk in using heat to treat pain is the possibility of a deep second or even third degree burn.

Ice on the other hand, actually produces anesthesia after it has been on for a time. Ice reduces swelling, and ice causes muscle guarding to cease. Ice also lasts for long after the ice has been taken off, whereas heat stops working as soon as it is removed from the skin.

The secret to the safe use of ice is that you need to combine ice and water to ensure that the temperature stays at O degrees Celsius. Ice plus water in a plastic bag on the skin for a half hour will numb the muscles of the back, reduce pain for up to two hours and will reduce swelling. You can ice every two hours for half an hour.

Ice is your friend, but make sure that you use ice plus water so that your don’t get freezer burn.

Posted in back pain, heat, ice, pain treatment | No Comments »