Motion LOWER BACK - Amazon S3 · 2015-08-14 · Pain Free Motion™ for your Lower Back 5 What is...

Pain Free Motion™

for your

LOWER BACKRelief without Medications,

Injections or Surgery

Pain Free Motion

™ for your LOW

ER BA

CK: Relief w

ithout Medications, Injections or Surgery W

ritten by: Chad Madden, M

SPT

Written by:

Chad Madden, MSPT

1Pain Free Motion™ for your Lower BackIntroduction

Introduction:

This book was written for YOU. The purpose of this book is to help YOU live a happier and healthier life. Contained are tools and information to give you a better understanding of the human body and a better understanding of your own body and your lower back.

As they say, “Knowledge is power.” The more knowledge you have about something, the better you can control that area of your life. The more knowledge you have about how your body works, the easier it will be for you to live a healthier life, to get more out of life, and to get your life back.

Read the book. Share it with people you want to help. Use it. Gain knowledge. And take control of your body and your life.

Happy healing!

Chad Madden, Physical Therapist

2 Pain Free Motion™ for your Lower BackContents

3Pain Free Motion™ for your Lower BackContents

Table of Contents

1 What is Pain? ............................................................5

2 Is There Hope? ........................................................13

3 What Can Be Done? ...............................................19

4 What is the Most Common Mistake People Make in Handling PAIN? .........................25

5 How do You Know if a Treatment is Handling the Cause of your PAIN? .....................35

6 What is the Best Treatment for YOU? .................43

7 What Causes Back Pain? .......................................49

8 9 Culprits .................................................................57

9 Putting it all Together ...........................................61

Appendix .......................................................................63

4 Pain Free Motion™ for your Lower BackWhat is Pain?Chapter 1

What is Pain?

5Pain Free Motion™ for your Lower BackWhat is Pain? Chapter 1

Wha

t is P

ain?

Chapter 1:

What is Pain?

Webster’s Dictionary defines pain as a “localized physical suffering associated with bodily disorder (as a disease or an injury).”

Pain originally meant revenge, penalty or punishment.

You feel pain in many ways. It is a part of your life. And while it may not be pleasant and is something to be avoided, how you respond to pain often determines how you feel later on.


What is Pain?

As a physical therapist, I am an expert in helping people handle pain. When someone comes in suffering from pain one of the first questions I ask is: “Is pain good or bad?” Most people answer “Bad”. A small percentage will say pain is a good thing. They say, “It is a sign, an indicator.”

Take a look at this …

Your body has five senses:

1. Sight 2. Sound 3. Taste 4. Smell 5. Touch You see with our eyes. You can see things which are bad and affect you in negative ways. You can receive pleasant sights such as seeing a loved one or a picture of a past family vacation which brings back fond memories.

You hear with your ears. You can hear bad things which disturb you emotionally. You can hear soothing sounds which relax you such as your favorite music.

You taste with the taste buds on your tongue. You can taste things which are bitter such as a lemon. You can taste things which are sweet such as a piece of chocolate.

You smell with your nose. You can smell a bad odor such as a skunk. You can smell something pleasant such as flowers.


Wha

t is P

ain?

You touch with your skin. You can sense heat, cold, pressure, and pain with your skin. Some touch is pleasant such as a massage or a pat on the back. Some sensations are not pleasant such as lower back pain.

So with each sense, there is information being sent to your brain. It may be good or bad or somewhere in between. The information helps you respond and take appropriate action.

What happens when you lose a sense?

Loss of the ability to see is blindness.

Loss of the ability to hear is deafness.

There is a name for a condition in which a person loses their sense of touch.

Do you know what it is? Leprosy. A person with leprosy, or leper, suffers nerve damage. This nerve damage prevents them from feeling pain and damage to the body. A healthy person steps on a nail, feels terrible pain, and


What is Pain?

gets the nail out of their foot. They receive the signal of pain and can take the right action. A person with leprosy, steps on a nail and does not feel pain. They may continue to walk and cause more damage. They do not feel pain and do not take the right action.

So be thankful you can feel pain!

Pain Free Motion™

Truth #1

Pain is a message with valuable information. Example

You are the Head of Systems of a large office building. Not one of those three story office buildings. You run the largest skyscraper in your city. The building is 100 stories tall and has 50 companies and 50,000 people living and working in it every day.

You have the responsibility of making sure everything runs smoothly. Heating and air conditioning, plumbing, water, electricity, phone and data lines, cleaning, maintenance, security, fire … you are responsible for it all.


Wha

t is P

ain?

Of course you have teams of people to help you run each of these areas. They do that by giving you daily reports on how each area is doing. You are the first to know when Elevator 11 shuts down, when the roof leaks, when the windows need cleaned and when your tenants are upset about the new carpeting installed in the hallway.

In order to successfully run a large building such as this, you need the best communication system. Each manager must be able to reach you immediately and you must be able to act immediately in the case of an emergency.

You receive information. What you do with it is up to you and will ultimately determine the “health” of your building and the people in it.

“Smoke alarms going off on the 7th floor”! Are you going to put that one off while you finish your game of solitaire? Probably not! You will act immediately … the lives of many depend on it.

Illustration

A delivery man rings your doorbell three times. You open the door. He hands you a giant package wrapped in bright yellow and pink tape that screams, “OPEN


What is Pain?

IMMEDIATELY”, “IMPORTANT”, and “FRAGILE”. What do you do? Would you ignore this and close the door? Would you take the box and throw it in a closet? Or would you run and open the package immediately?

Pain is a package … a package full of information. We can ignore it. Put it on the shelf in hopes of dealing with it later. Or we can find the cause of the pain and handle it.

Applying Pain Free Motion™

Truth #1to Lower Back Pain

Mary is in her early fifties. She walks for exercise, but not every day. Mary works a desk job and is in average health.

Mary and her husband decide to make the most of a sunny weekend and complete a few hours of yard work: raking, trimming and planting flowers. She goes to bed a little sore … but nothing more than expected. Mary goes to roll out of bed the next morning and can barely move. She feels a sharp pain in the right side of her lower back. The pain shoots into her buttocks and down her leg to her knee. Her leg feels heavy as she tries to walk to the bathroom. As she goes about her day, Mary feels pain getting dressed, getting in and out of the car and with sitting.

Truth #1 is “Pain is a message with valuable information.” In this case, Mary is experiencing pain. She


Wha

t is P

ain?

is receiving information letting her know that something is wrong. She has an injury and inflammation in her lower back. She may have a herniated or slipped disc. She may have sciatica. She may have stenosis or a problem in the pelvis.

Regardless, her body is letting her know that something is wrong. Why? Damaged tissue hurts. Healthy tissue does not. Mary can use this information and make good decisions to help her heal. We will talk about this in a later chapter.

Questions for You:

1. Is pain a good or bad thing? Why?

2. In the past year, what is the worst lower back pain you have had? (Rate between 0 and 10. 0 is no pain. 10 is severe pain.)

3. What is your body trying to tell you?

Want to Learn More aboutPain Free Motion Truth #1?

Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/17/mcF7VnKTPiE

12

Is There Hope?Chapter 2

Is There Hope?

Pain Free Motion™ for your Lower Back

13

Is There Hope? Chapter 2

Is Th

ere H

ope?


Chapter 2:

Is There Hope?

As a physical therapist, one of the first things I look at in helping someone in pain is the activity which causes the pain. The following is a list of common activities which cause lower back pain:

• Sitting • Standing • Walking • Goingupordownstairs • Sleeping • Gettingupinthemorning • Gettingdressed

14


Is There Hope?


• Leaningforwardatasink • Golfing • Lifting • Running • Crossingonelegovertheother • Puttingshoesorsockson • Stoopingorkneeling • Bending

When I am helping a person in physical therapy, I start with this question:

“Is the cause of the person’s pain something that can heal?”

From Truth #1 you know “Pain is a message with valuable information.” So you understand that you are in pain, you have information that something is wrong in your body. There is unhealthy, damaged tissue somewhere in your body.

In looking at the best treatment to help you heal, I want to find out what is causing your pain. If you have pain every time you do an activity such as walking, I now have more detailed information on what is causing your pain.

Truth #2If the pain is reproducible,

it is usually reducible.

15


Is Th

ere H

ope?


By “reproducible”, I mean when you do an activity, the pain increases.

By “reducible”, I mean the pain has the potential to decrease.

The good news is that when the pain is reproducible, there is a CAUSE. When there is a cause which can be handled, there is hope!

Example

Many people I work with in physical therapy believe that their condition is very rare and hopeless with no chance of healing. They have been discouraged with failed treatments in the past. Or they may have seen specialist after specialist, doctor after doctor, or therapist after therapist with no real change in the pain they are feeling. The same people who feel there is no hope often are surprised to learn that their condition is not rare and that I have helped hundreds of people with the same condition in the past year!

A new trend in healthcare is the growing number of people who are seeking treatments without medications, injections and surgery. People recognize the body has a natural ability to heal and seek ways to increase that ability!

As a Physical Therapist, it is my job to help people heal the problem that is causing their pain. Not all problems causing pain are able to be healed with physical therapy …

16


Is There Hope?


but there is good news, most problems can be healed with physical therapy treatment.

An example of a problem which can not heal with PT is cancer. Physical therapists are trained to look for signs of cancer when we are working with a person. One common sign of pain caused by cancer is that regardless of the person’s activity, the pain stays about the same. When a therapist is working with a person whose pain is not reproducible, this is a “red flag.” That person needs to be referred back to the family doctor for further testing.

An example of a problem which can heal with PT is a herniated disc. A person with a herniated disc often experiences lower back pain and sciatica (pain shooting down the back of the leg). Pain from a herniated disc is likely to be reproduced with activities involving bending over or bending forward, sitting for long periods of time, lifting, sneezing or coughing. Again, if the pain is reproducible, it is often reducible … and there is hope!


Truth #2

In the first chapter, we discussed Mary who had right side lower back pain radiating down her leg. Her pain was reproduced or increased with sitting. If Mary sits for more than 15 minutes, she begins to feel shooting pain and heaviness in her right leg. She also feels an increase of pain in the back.

17


Is Th

ere H

ope?


In this case, Mary’s pain is reproducible. Sitting reproduces her pain. Since that is the case, her pain is most likely reducible. This is because her pain is caused by a problem in the muscles, nerves, tendons, bones or ligaments in the body.

Questions for You:

1. In the past month, what is the worst pain you have had?

2. What were you doing when you felt the pain?

3. Is your pain reproducible?


Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/15/kl9Y0L2FFYw

18

What Can Be Done?Chapter 3

What Can Be Done?


19

What Can Be Done? Chapter 3

Wha

t Can

Be Do

ne?


Chapter 3:

What Can Be Done?

Truth #3You have a choice in how you handle your pain.

Example From Chapter 1, you realize you continuously receive information from different indicators.

In an office building I used to work in, we had a small leak in the ceiling in the middle of the gym. The leak did not seem to do much damage, but it always left an ugly,

20


What Can Be Done?


brown stain in the white ceiling tile. I noted that it only leaked when it rained hard and was windy at the same time. If the weather brought heavy rain, snow, sleet, freezing rain, or even hail without wind … no leak.

After changing the ceiling tile out 3 or 4 times, I climbed a ladder, pulled the ceiling tiles to the side and tried to find where the leak was coming from. I am a Physical Therapist for a reason … and fixing leaks is not my God-given ability. No luck.

I called a roofing company. They flooded the roof with 500 gallons … no leak. The roofing company reported that it was “most likely” coming from the heating and cooling units on the roof. We called the heating and cooling company. The heating and cooling company made some repairs. No change … the small leak continued whenever the weather was a combination of heavy rain and strong wind.

3 roofing companies and 10 ceiling tiles later … the leak was still there. I had several choices:

First, I could have ignored the problem all together and left the stained ceiling tile up. Ignoring the problem is usually not the best choice as it often leads to bigger problems down the road.

Second, I could have tried to alter or change the information. In fact, by changing the ceiling tile after every leak, that is exactly what I was doing. Was I addressing the

21


Wha

t Can

Be Do

ne?


cause of the leak? NO. But our ceiling looked great until it rained again!

The third option was to address the cause. Then again, if you have ever tried to find a leak on a 4,000 square foot flat roof … the cause can be difficult to find.

There is a happy ending to the story as a roofer named Brian was performing other maintenance on the roof and found the cause of the leak. He patched it up and saved me lots of time climbing up ladders and a small fortune in ceiling tiles. Thank you Brian!


Truth #3

Working with a wide range of people in the PT clinic, I have noticed general truths in a person’s health and how one handles problems with the body:

Healthy people address pain immediately.

Unhealthy people ignore pain or try to alter it.

This is no different for any area in our life. Have you ever ignored a problem and it magically went away? Rarely. Relationships, marriages, finances, health or the conditions of our life rarely get better when we ignore it.

In the case of Mary with the right side lower back pain

22


What Can Be Done?


radiating down her leg, she can:

1. Ignore it. “Oh, it will go away in a day or two.” There are many excuses she can come up with to explain the pain away. Regardless, Mary has a problem and it should be addressed, especially if she plans on helping with yard work in the future.

2. Try to change it. Mary can sit in a hot tub, use a heating pad, take an anti-inflammatory medicine or try to block the pain in a variety of other ways. Often she will do this together with “taking it easy” for a few days. Usually, the inflammation and pain decrease. Yet the pain will likely come back.

Why? She has not handled the cause of the problem.Mary may also change how she does certain movements. Usually we say a person is compensating when they do this. Mary’s pain increases when she sits. Logically, she may lean to the left to take pressure off of her right side.

3. Handle it. Mary waits a week. The pain is a little better, but continues to bother her with sitting. The pain is shooting down into her leg. She calls her physical therapist and makes an appointment to get the problem handled.

As a PT, I am a little biased to #3. Then again, I have seen people suffer with lower back pain for more than 50 years prior to seeking treatment!

23


Wha

t Can

Be Do

ne?


Questions for You:

1. What signs or information in your life have you ignored? What was the result?

2. Can you think of a time you ignored a problem and it went away on its own … and stayed away?

3. What examples can you think of when a person may change or alter their signs and information they are receiving?

4. Think of a person who is good at handling problems of the body. How is their overall health?


Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/20/6eLIxQFC6ww

24

What is the Most Common Mistake People Make in Handling PAIN?Chapter 4

Handling PAIN


25

What is the Most Common Mistake People Make in Handling PAIN? Chapter 4

Hand

ling P

AIN


Chapter 4:

What is the most commonmistake people make in handling PAIN?

The easiest thing for you to do in any situation is to do nothing.

It takes very little effort to make excuses as to why you have a problem. It takes effort to face the problem and handle it.

A wise quote is “We spend split seconds making decisions and spend the rest of our lives justifying them.”

This happens with pain frequently. You feel back pain doing an everyday activity such as lifting something around the house or turning the wrong way. You are convinced you only have a muscle spasm and it will go away in a day or two. A week later, the pain is still there. You have not done much all week as moving “the wrong way” hurts. Now you justify that you must have a bad back … just like your Uncle Barry. And you sit at work all day. And you never got around to getting back in shape like you were going to. And you are carrying a few extra pounds. And you had an injury playing sports when you were younger. And …

While your ego is searching for any reason to justify

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Handling PAIN


why you are in pain, you are doing nothing at all to address the cause.

By far the easiest thing to do in handling pain, is to ignore it … and make a load of excuses as to why they will not heal. It takes less effort to come up with excuses than to actually handle the cause of the problem.

So I give you Pain Free Motion™

Truth #4

The most common mistake people make in handling pain is they ignore it.

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Hand

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AIN


If you want to make an excuse as to why you are unable to heal and will live the rest of your life in pain, feel free to choose from the list of my favorites:

10. “My _________________ had the same problem.” (fillintheblankwithanyrelative:Mom,Dad, sister,brother,Uncle…whatdotheyhavetodo with you anyhow!?)

9. “I’vealwayshadabadback.”

8. “Ihavearthritis.”

7. “Ihavefibromyalgia.”

6. “Idon’thavetime.”

5. “Mybodyisdifferentthaneveryoneelse’s… there is something wrong with me.”

4. “It’sanoldinjury…nothingcanbedoneabout it now.”

3. “Ihavealreadytriedeverything.”

2. “IdoPhysicalTherapyalready…Igotexercises off the internet.”

1. “IhadanMRIandIhaveabulgingdisc.”

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Handling PAIN


When I see a person with back pain and he tells me he will always be in pain … he is right.

When I see a person with back pain who says, I am willing to do whatever it takes to get rid of this … he is right … and gets better.

Your words, self-belief and views of yourself determine whether you will get better or not.

Look, you should expect to heal.

I’ll repeat that just to clarify … YOU SHOULD EXPECT TO HEAL. How is that? If you were in the kitchen and accidentally cut your finger and had a small bleed, how long would you expect to keep bleeding? If you put a band-aid on the cut and took it off three days later, would you expect to see the cut still bleeding? Of course not! See, caught you expecting to heal …

The fact is 97% of your body is completely new from a year ago.

New nails, new hair, new blood, new skin. You are constantly making a new you. You are constantly healing. Regardless of your history, your family’s history, or your present situation, you are healing. If you are breathing and your heart is beating, there is a really good chance you are healing.

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Hand

ling P

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Have you ever gone on a long walk and felt sore a day or two later? How long did that last? See, caught you healing again! If you do a new activity, one that you are not used to, you probably will be sore a day or two later because of the muscle breakdown. Your body heals and you actually become stronger than before! Constant healing …

Example In Chapter 1, you were the person in charge of a large, skyscraper building.

You receive information reports from the buildings systems:

Heating and air conditioning, plumbing, water, electricity, phone and data lines, cleaning, maintenance, security, fire, leasing arrangements.

Now imagine the Director of the heating and air conditioning comes to you in an emergency and informs you that half of the building is not getting air conditioning …

And … it’s July and 97 degrees.

You have the same choices here:

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Handling PAIN


1. Ignore it.

2. Try to change it.

3. Handle it.

If you ignore it, you are on your way to losing tenants and your job.

If you try to change it by giving everyone free ice cream or putting box fans in every office, have you addressed the cause of the problem? Maybe for the short term at best …

Handle it. Everyone in the building is happy. Pick up the phone. Call an expert in heating and air conditioning and get the problem fixed to the point that it does not happen again.

Why would you treat your body any different?

Interesting Note Did you ever hear of the black box they look for in airplane wreckages? It holds information and recordings of information of what was going on in the plane before it crashed. Studies of those black box recordings reveal that the most common problem made is the pilots ignore the signals and information they were receiving directly before the crash.

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Hand

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Applying the Truth

The above diagram represents your life and all of the activities you do in your day to day living. The outer boxes represent activities which require more strength, more energy, more flexibility, more health and more endurance such as running, twisting, and lifting. The inner boxes represent lighter, easier activities such as sitting or lying down.

Now here is what happens over the long term when you ignore pain:

In your 20’s and 30’s, you likely experience very little, long lasting, debilitating pain. You can help a friend move furniture, do hours of yard work and walk a few miles with minimal problems. Maybe you have a little soreness the day after, but it does not last long. Your ability to heal is high at this point in your life. It is only when you lift something very heavy or run or perform some other high intensity activity that you have pain. At this age, with the inflammation resolving in a day or two, you convince yourself to ignore the pain. “It will go away.” You will just be a little more careful next time. You ignore the signal and eventually lose the ability to do the activities in that area of your life.

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Handling PAIN


Eventually, as you move into your 40’s, you stop lifting heavy objects or running altogether. Now, you begin having pain if you do too many stairs or walk a few miles. You now need to take a break as you are driving the 4 hour trip to the beach for vacation. As long as you continue to ignore your problem, it continues to get worse. You eventually begin compensating when you walk or take the stairs. “I am not as young as I used to be” you may reason. You have ignored the signals again and the activities you can do are decreasing.

In your 50’s, you may start leaning on the grocery cart to help you make it through the grocery store. Standing for anything longer than 30 minutes is now tough. You begin taking breaks any time you sit, stand, or walk for a few minutes. It now takes an hour or so for the stiffness to go away when you get up in the morning. Getting dressed in the morning is a real challenge. “I’m getting old.” Life is less and less about what you can do and more about what you cannot do. You might even be sleeping in a recliner at this point.

In our 60’s and 70’s, you may now be facing total knee replacements and be looking for any sort of relief as the pain is with you for most activities. The only time you are not in pain is when you are sitting in your favorite recliner or lying down. You are now boxed in living your life through only a few basic activities.

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Where did you go wrong? Why is it some people stay very active into their 90’s and beyond and others can barely move in their 50’s?

Is it your genetics? Maybe that plays a small part. Genetics does set our potential.

Is it a magic pill? Doubtful, as large populations of people around the world stay active and have minimal arthritis without the latest multivitamin or wonder drug.

It is most likely the way you prevent and handle problems as they happen in your body. Ignore it and you likely will lose most of the activities you want to do. Handle it and you can still be dancing well into your 90’s and beyond.

Questions for You:

1. Think of the worst pain you have felt in the past year. When was it?

2. What were you doing when you felt the pain? What caused it?

3. How did you handle the pain?

4. Did you ignore it, change it or handle it?

34

How do you know if a treatment is handling the CAUSE of your pain?Chapter 5

Treatment of

CAUSE of your pain



Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/25/f3GP6ffmfxY

35

How do you know if a treatment is handling the CAUSE of your pain? Chapter 5

Treat

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Chapter 5:

How do you know if a treatment is handling the CAUSE of your PAIN?

You have heard the statement “For every action there is an equal and opposite reaction.” This is one of Newton’s Laws of Gravity. For every effect there is a cause. Things and events do not randomly happen without a cause. Sometimes you may not see the cause. Or you may not know exactly what the cause is. Regardless, there is still a cause. It is a law.

Imagine if a man were driving down the road. One of the tires on the car goes flat. Was this a random happening? Did the tire simply decide to go flat? Was the air in the tire looking for a change of view and wanting to get out and see the world? In this case, as with most flat, they seem to happen after an unwanted hole is in the tire. Sometimes it is a nail or sharp object. Sometimes the tire is blown out or worn out.

In this example, the effect is the tire going flat and not holding air. The cause is the hole in the tire. The sooner our driver … or AAA … finds the hole and fixes it, the sooner he can be on his way.

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Treatment of

CAUSE of your pain


Example

Cause: Throw a pebble in calm water. Effect: Observe the ripples caused by the pebble.

Cause: Turn a light switch off and on. Effect: The light bulb goes off and on.

Cause: Expose steel to the air and water. Effect: Oxidation and rust.

Cause: Eat more food than we need. Effect: We gain weight … gain fat.

Cause: Exercise. Effect: Lungs, heart, muscles work better.

Cause: Out of shape? Try running up 5 flights of stairs. Effect: Wheezing and out of breath.

Cause: Ignore a problem. Effect: It gets worse.

CAUSE AND EFFECT.

Truth #5You can see and measure what is

pretend help and what is true help.

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Pretend help are treatments that pretend to address the cause of the problem, but really do not help you long term.

True help is treatment which does address the cause of your problem. True help results in healing and relief that lasts.

What is Pretend Help?

Think of the last time you had lower back pain. OK, what were you doing? Sitting? Standing? Walking? Bending forward?

When you had the pain, how bad was it? 5 out of 10? More? Less?

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Treatment of

CAUSE of your pain


After you had the pain, what did you do next? You stopped doing that activity, right? If you were standing, you shifted your weight or sat down. If you were walking, you stopped walking or changed the way you were walking.

You may have even grabbed a smelly blue gel and rubbed that all over your back and sat on your recliner for an hour or two. Or better yet, used a heating pad. If you had a 5 out of 10 pain when you were walking for 15 minutes, put the magic blue stuff on and stopped walking did you address the cause of the problem? Trick question …

Walk again. Same speed. Same distance. Same everything. Did the pain come back? If it reached a 5 out of 10 again after 15 minutes, have you addressed the cause of the problem with the blue gel?

No.

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10

Pain level — (1=low to 10=high)

5/10

4/10

3/10

2/10

1/10

TRUE HELP

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10


5/10

4/10

3/10

2/10

1/10

PRETEND HELP

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Illustration of Pretend Help.

Now let us say you put a heating pad on your back to help with sitting. Is this Pretend Help or True Help? It is Pretend Help, the pain comes back at the same intensity when you go back to sitting. We call this the “Roller Coaster Effect.” Your pain climbs to a 7 out of 10. You put the heating pad on and gets some temporary relief. You stand up to walk around. The pain goes down. You go back to sitting and the pain is in the same location and the same intensity.

With Pretend Help, you are not addressing the cause of the problem.

This can go on as long as you want to stay on the roller coaster. I have worked with customers who have been doing this “Roller Coaster” for more than 50 years! It was not that they did not want to get better or were not trying. The problem was that they were not doing or were not working with someone who knew HOW to address the CAUSE of the problem.

How is True Help different?

With True Help, you receive treatment to handle the cause of the problem. Later in the book, I will give you the 3 common causes of lower back pain. One of the causes of lower back pain is arthritis. Let’s assume you have arthritis in your lower back. If you are reading this book, are American and over the age of 50, chances are you have

40


Treatment of

CAUSE of your pain


lower back arthritis. You go to a Physical Therapist to handle the problem. The therapist does testing. He finds you have pain when you bend backwards and have relief when you bend forward. This is why you lean on the cart when grocery shopping. The therapist treats the problem and helps your lower back move again. You go to the grocery store the following week. The pain is much less!

Did you and your therapist handle the cause of the problem? Yes.

With True Help, the pain is less intense or has changed location because you have addressed the cause of the problem.

The pattern and test of True Help is this:

1. Find an activity that makes your pain worse.

2. Have a therapist or doctor test for the CAUSE of the pain.

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10


5/10

4/10

3/10

2/10

1/10

TRUE HELP

Week 1

Week 2

Week 3

Week 4

Week 5

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3. Treat the CAUSE.

4. Retest the activity. If you have addressed the CAUSE, your pain should be less. Immediately.

What is the Best Treatment for YOUR Pain?

You can walk into any pharmacy or supermarket and find a shelf after shelf of different treatments for pain. The latest gadgets and gizmos for back pain are available on TV … if you want to stay up until 3 in the morning. Famous basketball and football players endorse blue creams and heat packs for joint pain. The number of treatment options can be overwhelming if you do not know how to sort through the mess. Here are a list of a few treatments for back and joint pain:

• Heat• Ice• Medicine(anti-inflammatories,muscle relaxants,pain killers)• Surgery• Injections• Herbalremedies• Jointjuice• Vitaminsandsupplements(glucosamine)• Massage• PhysicalTherapy• Exercise• Chiropractic• ElectricStimulation

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• Ultrasound• Laser• SportsCreams

From Truth #5, you know that you can look at a treatment and see if it is truly addressing the cause of the problem and truly helping you OR pretending to address the cause and only pretending to help you.

Fortunately, for the guy who throws his back out and would rather just find the best possible treatment now instead of testing every product in Aisle 9 at a local drug store, there is a quick, easy answer: RESEARCH. In Physical Therapy, I use research to select the best treatments for you. What has worked for thousands of others with similar pain and the same CAUSE as your problem, will likely work for you.For example, in the treatment for lower back pain, 3 things have stood the test of time. I will discuss what works in the next chapter …

Questions for You:

1. What treatments have you tried in the past?

2. Were they pretending to help? Or were they truly helping?

3. Do you still have the pain now?

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Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/16/a1vZEHCG_mA

ANDwww.youtube.com/maddenptofficial#p/u/18/Ipwh_jdhnEI

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Chapter 6:

What is the Best Treatment for YOU?

You now understand that to have long term relief, you are going to address the cause of your problem. How do you do that?

3 Treatments have stood the test of time for lower back pain:

1. Exercise.

2. Manualtherapy(alsoknownasHands-on, mobilization or manipulation).

3. Traction.

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1. Exercise.

Remember back in the 1950’s and 60’s? What was the standard treatment for lower back pain? BED REST. Days which turned into weeks of bed rest.

Back strain?

BED REST.

Back spasm?

BED REST.

Herniated disc?

BED REST.

Arthritis?

BED REST.

Sounds exciting … huh?

Well, luckily it is now known that bed rest is actually likely to cause more harm than good. The latest research shows that one of the best things you can do for back pain is to keep moving!

Why does exercise work?

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When your back is painful and inflamed, you have damaged tissue. Damaged tissue is painful. If you do not move, healing is slow. When you do move, even if it is light exercise or walking slowly, blood flow increases. This speeds up the healing process as damaged tissue is removed and the building blocks for new tissue is delivered to the injured area. Out with the bad, in with the good.

Think about this: Would you rather drink from a flowing, mountain stream or a mud puddle? And not just any mud puddle, but the kind with mosquito eggs and bugs floating on the top?

Mountain streams are used in beverage commercials because they represent clean and healthy water. Mud puddles are not because they represent stagnant flow and disease.

Flowing is healthy. Still, cesspools are not healthy.

People who move their bodies are healthy. People who do not move their bodies are not healthy.

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What is the best exercise for your back pain?

Not all exercises treat the same problem. As I will cover in the next chapter, there are three common causes of back pain.

The key is to do the right exercises that are the right ones for your problem.

Good idea!

Find “Madden PT” on Facebook, youtube or Twitter for the Top 3 Exercises for your back pain.. 1. Manual Therapy

Manual therapy goes by several different names:

Mobilization

Manipulation

Hands-on Therapy

Regardless of the exact word, the concept is that the therapist is using a hands-on technique to help you move better.

Example.

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A person comes in with pain every time they bend backwards. They feel “blocked” or “tight” moving in a certain direction. The Physical Therapist does a hands-on technique to help them move through the barrier. This is usually pain free and results in an immediate improvement.

When therapists restore normal movement in your joints and you do exercises to retrain your muscles which control your joints, something amazing happens … you get long term, permanent relief.

Some people get on the Manual Therapy Roller Coaster. Every time their back goes out or they have a “crick” in the neck, they run and get manual therapy. The key to preventing the pain from coming back is EXERCISE. Exercise retrains and reteaches your muscles how to move the right way. If you do the right exercises, you should not need to go back and get manual therapy or manipulation over and over.

People who only exercise without receiving manual therapy at least initially, often end up only retraining bad movement patterns and may experience only limited relief with exercise.

Formula for Permanent Relief:

Manual Therapy to Restore Normal Movement+

Exercise to Retrain the Muscles

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What is the Best

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Get moving … then retrain the muscle so it does not happen again.

3. Traction

Traction, or its close relative Decompression, is effective for a few types of back pain.

The first is arthritis (which is similar to disc degeneration and stenosis). With arthritis, the bones (called “vertebrae”) in the spine become closer together. Traction is effective at increasing this space and preventing the problem from getting worse.

The second type of problem traction helps is sciatica. This is when pain shoots down into the leg. This is tricky, as the cause of the problem is not in the leg … but in the back. Pain is in the leg, problem is in the back. Relieve the pressure on the nerve in the back and the leg pain goes away.

Truth #6

The most effective treatmentsfor lower back pain are hands-on treatment,

exercise and traction.

Successful treatment involves your physical therapist finding the cause of your problem and then using the right combination of exercise, manual therapy and traction to handle that problem and help you heal.

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Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/19/2ezF7ju3xJI

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What is the Best

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Chapter 7:

What causes back pain?

The Top 3 Causes of Lower Back Pain are:

1. Arthritis,Stenosis,DiscDegeneration

2. Herniated Disc

3. Pelvis

What is it?

Don’t you love the BIG, confusing words above?Here is what they mean:

Arthritis, Stenosis and Degenerative Disc Disease (abbreviated DDD) are similar.

What is arthritis? It literally means “joint inflammation.”

What is stenosis? It is the narrowing of the canals or tunnels in the bones where the nerves travel.

What is Degenerative Disc Disease? This is when the space between the bones in the spine decreases.

Rarely will a person have DDD which does not cause

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stenosis and lead to arthritis. The 3 are closely linked and generally cause the same symptoms.

How It Works.

In a healthy spine, there is plenty of space between the bones (also known as vertebrae). As you age, or have injuries, this space closes down. This is Degenerative Disc Disease.

As the space closes down, the hole narrows where the nerve branches off of the spinal cord. This is stenosis.

As the space decreases and the area becomes inflamed, arthritis forms in the joint.

Symptoms.

First, realize that most people over the age of 50 have Degenerative Disc Disease, stenosis or arthritis on an X-ray or MRI.

Second, people suffering from back pain caused by DDD, stenosis or arthritis have difficulty standing or walking for long periods of time. They usually find relief sitting or bending forward. Often you will see them leaning on a shopping cart when walking through the grocery store.

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1. If you have Arthritis, DDD or stenosis, will your condition get worse?

No, if you do something about it.

Yes, it will get worse if you do nothing.

There are successful treatments for arthritis, DDD and stenosis. Most people can become completely pain free or close to it and prevent the pain from getting worse without medications, injections or surgery. Traction, hands-on treatment and exercise are proven methods for getting lasting relief.

A person suffering and seeking treatment will not be 18 years old again, but can move in the right direction.

If you have arthritis, the sooner you address it, the more hope and healing there is for you.

2. Herniated Disc

The progression of a disc problem from good to bad is as follows:

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• Healthy disc• Bulging disc• Herniated disc• Ruptureddisc

What is it?

As a disc bulges, herniates and ruptures, it puts an increasing amount of pressure on the nerves in the spine. This leads to pain and can eventually cause numbness, tingling and pain down into the legs. This is commonly called “SCIATICA” (pronounced SI-ATTIC-A) or a pinched nerve.

How it works.

There is a space between the bones in your back. In this space there is a disc. The disc acts as a shock absorber to help with forces in your spine.

The disc is surrounded by a gel like substance. This is held together by a wall of fibers. Sometimes the fibers can break down and allow some of the disc and gel to push out and put pressure on the nerves in the lower back.

Common Symptoms.

Most people suffering from lower back pain and sciatica from a herniated disc have pain bending forward, lifting, coughing, twisting and sitting. The pain is relieved with bending backwards or standing.

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Can you heal a herniated disc?

MRIs. If you took an MRI of 100 people without pain, how many would have a herniated disc or other disc problem? 80.

From research and personal experience, I have worked with people who were suffering from severe back pain and sciatica AND had a positive MRI for a herniated disc. Several were experiencing weakness in their legs.

One specific instance involved a man in his thirties who had foot drop (he could not pull his foot up). He had a herniated disc on an MRI. After 4 weeks of PT, he regained the strength in his leg and was able to run 3 miles without problems.

Did he go back and get another MRI to see if the disc had healed? Of course not! I doubt the insurance companies want to pay for an MRI on a person who is now healthy and healed.

3. Pelvis

If you look at a stack of blocks on a table, what is the most important block?

The top block? If you move it, does it affect the other blocks below?

What about the block on the bottom? If you move it, do the other blocks fall over? Sure!

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The block on the bottom is the foundation. Your back works the same way. The bones in your spine form a stack resting on your tailbone and pelvis.

If you have arthritis or a disc problem in your lower back, there is a good chance you have a problem in your pelvis as well.

When I first began as a PT, I treated everyone with lower back pain as either an arthritis problem or a herniated disc problem. 25% of people did great and were better in a few weeks. 75% either did the roller coaster where they would feel better for a little while OR therapy would irritate them.

Once I learned to look at the pelvis and handle the problems there, I was able to help people with stubborn disc and arthritis pain much better.

Bonus Truth:

If you have had back pain for years, you probably have more than one problem in your back.

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How it worksThere are 3 bones and 3 joints in the pelvis:

The 3 joints need to be moving and need to be stable for you to move without pain.

Common Symptoms

If you have a problem in your pelvis, you likely have pain rolling over in bed, getting in and out of the car, walking, sitting for long periods, crossing one leg over the other and getting dressed.

You will have pain here or in the groin.

Is there hope for pelvic problems?

Successful treatment involves getting your pelvis to move the way it is supposed to. This involves receiving hands on treatment from a skilled physical therapist.

After your pelvis is moving the way it is supposed to, you need to retrain the muscles in your stomach and lower back. This will help you heal and prevent the problem and pain from coming back in the future.

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Go to the Madden PT Official page: video link.www.youtube.com/maddenptofficial#p/u/23/wUyZpNToVpI

ANDwww.youtube.com/maddenptofficial#p/u/22/e5aKGZi-RRU

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Chapter 8:

9 Culprits:

Little Things you do everyday To cause BIG Problems in your back.

1. Sit on your wallet. Bad idea. I know it’s a habit … and your wife thinks it’s cool that you have a wallet mark on the back pocket of your Levi’s … but your back does not agree. There is no prize for having more receipts stuffed in your wallet than George Castanza. Sitting on your wallet, even if there’s no money in it, causes a shift in every bone in your spine. Long term, it creates uneven wear and tear on your back.

Good idea: Switch it to the front.

2. Crossing your legs. At the ankles, at the knee, on the couch, leaning to the side, in standing, lying in bed, when you are sitting … it does not matter how and when you cross your legs. Long term doing it day after day, causes stretching of ligaments which hold your pelvis together.

3. Standing with your weight shifted. If you are a long time back pain sufferer, you have probably developed little compensations you do throughout your day to minimize your pain. One such error is putting more weight on the other when you are standing. Keep it even.

62 Pain Free Motion™ for your Lower BackCulpritsChapter 8

Culprits

4. Poor lifting techniques. Bad advice: “Keep your back straight and use your legs”. If you take this to mean:

You are in trouble. Better instruction is to think “Keep your back arched, while using your hips and legs to lift.”

5. Lousy sitting posture. Hunch your shoulders and keep your back arched. Tough to do both, right? Keeping your shoulders back while you sit will help you keep the slight arch in your lower back as well.

6. Sitting in a seat with your knees above your hips. If your hips are slightly higher than your knees, it is easy to keep a slight curve in your back. If your knees are higher than your hips (which they usually are when you are riding in a car), it is difficult to keep an arch in your back.

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7. Running a vacuum or shaving your legs with one foot on a bench. Both of these movements “shear” you pelvis. This means that half of your pelvis is rotating one way while the other half is rotating the other way. Long term this creates uneven wear and tear on your pelvis.

8. Sleeping on your stomach. Bad idea. It is best to sleep on your back. Second best option is to sleep on your side. Sleeping on your stomach speeds up the process of developing lower back arthritis, stenosis and disc degeneration.

9. Lifting and twisting. The combination of lifting something and twisting at the same time puts stress on the discs in your lower back. This is a good way to herniate a disc in your back.

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Chapter 9:

Putting It All Together.

You control your body.

You can have good control where you pay attention to the messages and information you receive. You can put out fires as soon as they happen and prevent them.

Or you can let small problems become big problems.You can make healthy eating, exercising and resting decisions. You can seek out the best healthcare professionals in your area and use their advice.

Or you can make excuses.

Your choice … it’s your body!

As an extra bonus, I give you a personal Physical Therapy truth:

100% of the people who think that there is no help for their condition are correct. I have never been able to help someone who sincerely believed that I could not help him.

People who believe they can be helped usually can. At least they are looking for a solution and leave the door open to receive help.

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Success Stories

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Chapter 10:

Success Stories

“My experience here was great. I couldn’t get down on the floor to play with my children, sit in the truck for longer than 15 minutes, or vacuum at work with a backpack. Thanks to your staff I feel 100% better and am now able to get back to my normal life.”

— AC, Harrisburg

“When I first came to Madden therapy, I was real stiff and had a hard time to walk. Now I can move around real good and do not have a lot of pain in my back and leg. I can walk much better and I have no fear of walking, thanks to Physical Therapy.”

— MF, Harrisburg

“Although I was hesitant about PT, it has greatly improved my life. I no longer have the amount of pain in my back and neck. Simple tasks as driving and housework no longer cause me pain. I also feel that being educated about the pain and given exercises will help me to be pain free. Thank you.” — BB, Harrisburg

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Success Stories

Success Stories


Want to Learn More aboutSame Day before and after treatments

with Pain Free Motion™?Go to the Madden PT Official page: video link.

www.youtube.com/maddenptofficial

69Pain Free Motion™ for your Lower BackAppendix

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How to do it:1. Lying on your back, grab your knee with both hands.2. Keep your other leg straight.3. Push your knee down into your hands.4. Keep breathing.Hold 5 seconds, 10 times.DO NOT hug your knee to your chest! What does it do?This exercise fires muscles in your buttocks and helps half of the pelvis rock in one direction.

How to do it:1. Lying on your back with knees bent. 2. Ball between the knees.3. Slightly arch your back by pressing your buttocks into the table.

Slightly tighten your stomach muscles.4. Squeeze the ball.5. Keep breathing. DO NOT bear down or strain.Hold 10 seconds, repeat 10 times. No Ball?A pillow off of your couch or a folded pillow will work just fine!

How to do it:1. Lying on your back with knees bent.2. Band around knees.3. Slightly arch your back by pressing your buttocks

into the table. Slightly tighten your stomach muscles.4. Spread knees apart.5. Keep breathing. DO NOT bear down or strain.Hold 5 seconds, repeat 20 times.

1 Single Knee Isometric

2 Ball Squeeze

3 Knees Apart with Band

Top 3 Home exercises for pelvic pain

Appendix

Appendix

70 Pain Free Motion™ for your Lower Back

How to do it:1. Lying on your stomach, prop up on your elbows.2. Keep breathing.Hold for up to 2 minutes. Too Hard? Try This …1. Same position.2. Lay on a pillow under your chest with arms at your side. What Should I feel?If your pain is coming from a herniated disc, you should feel less pain in your legs and more in your lower back.

How to do it:1. Lying on your stomach, hands in push-up

position.2. Keep hips and pelvis on floor, press upper

body, head and chest up.Hold 5 seconds, repeat 10 times. Too Hard? Try This …Instead of placing hands underneath shoulders, move them forward or up 6 inches and decrease how much you bend back.

How to do it:1. Standing with hands placed on the small of

your back.2. Bend backwards.Repeat 20 times.

1 Prop-Up on Stomach

2 Press-Up on Stomach

3 Standing Back Bend

Top 3 Home exercises for HerniaTed discs in the Lower Back and sciaTica

71Pain Free Motion™ for your Lower BackAppendix

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How to do it:1. Lying on your back with knees bent. Feet on the mat or bed.2. Keep shoulder blades on the mat and feet and knees together.3. Rotate knees to the right side.4. Then to the left.Alternate right, then left. 20 times each side. Good Idea!For those with early morning back stiffness, this works well before getting out of bed.

How to do it:1. Lying on your back, hug both

knees toward your chest.2. Keep breathing.Hold 5 seconds, repeat 10 times.If hugging your knees is to difficult, wrap a towel or belt behind the knees and pull to chest. Why It Works:This movement increases the space between the bones in your back.

How to do it:1. Lying on your back, hug one knee toward

your chest.2. Keep other leg straight down.3. Keep breathing.Hold 5 seconds, repeat 10 times on each leg.

Top 3 Home exercises for ArTHriTis in the Lower BAck

1 Trunk Rotation

2 Double Knees to Chest

3 Single Knee to Chest

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About the Author – Michael Gilbert, DPT

About the AuthorChad Madden, MSPT


Physical Therapist:Chad Madden, MSPT

Chad is the founder of Madden Physical Therapy. After graduating from Central Dauphin High School, he earned a Master’s Degree in Physical Therapy from College Misericordia in Dallas, PA.

His professional experiences include treating professional, college and scholastic athletes for sports injuries focusing on knee and shoulder rehab. In the past 10+ years, he has specialized in helping many find relief for lower back injuries, neck pain and other orthopedic problems.

“It was great growing up in the Harrisburg area. I am thankful to many people in the area who have helped me along the way: family, teachers, friends and neighbors. It is a blessing to be able to serve the same people and the Harrisburg area with a service that is needed and wanted. There is nothing like the feeling of helping someone with pain, when only a few years ago they were coaching me, teaching me or helping me in some other way.”

Chad presently lives in West Hanover with Stephanie, his wife, and 3 sons. They enjoy playing with Sophie – the family dog, playing baseball, wrestling, karate and making smores on Saturday nights on the patio. They are active in supporting community organizations including The Kids Trust, CBMC, Bethesda Mission and Morningstar Pregnancy Services.

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