Low back pain in older adults

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include mainly osteoarthritis and stenosis of spine.

Symptoms: Lower back pain and stiffness that is the most pronounced in the morning and in the evening

Includes any combination of the below symptoms:

Pain that interrupts sleep

Pain that is most pronounced first thing in the morning and again toward the end of the day

Localized tenderness when the affected area of the spine is pressed

Aching, steady or intermittent pain in the lower back that is aggravated by extended activity

Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)

Possible cause: Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.

Symptom: Leg pain that occurs primarily when walking and standing upright

Includes any combination of the following:

Unable to walk far without developing leg pain

Lower back pain relief is achieved quickly after sitting down

Symptoms fluctuate between severe and mild/none

Symptoms develop gradually over time

Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs

Likely causes: Lumbar spinal stenosis or degenerative spondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.

Symptoms: Sudden onset of back pain, limited flexibility, height loss

Includes any of the following:

• Sudden onset of back pain
• Standing or walking will usually make the pain worse
• Lying on one's back makes the pain less intense
• Height loss
• Limited spinal flexibility
• Deformity and disability

Possible cause: Spinal compression fracture

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less Common Causes of Lower Back Pain

While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:

• Piriformis syndrome
• Infection
• Spinal tumour
• Fibromyalgia
• Snkylosing Spondylitis
• Coccydynia

Why runners with back pain is not getting better

All of us treat back pain in our practices.  It can easily be as much as 50% of our patient population, which has led to many schools of thought.  Do I manipulate?  Do I use the algorithms from McKenzie?  Should I strengthen the core?  All of these have their time and place and are each incredibly valuable for the right patient!

For years, I used these schools of thoughts, but still often struggled with a specific population – RUNNERS. Runners are supposed to come in with aching knees, IT Band Syndrome, Achilles Tendon pain, but back pain?  Yes, more often than you might think, they complain of back pain.  It’s not that manipulating a runner’s back is not helpful and plenty of us could benefit from a few extra planks, but there’s something more.  If you don’t address this, the likelihood of the back pain returning is high because you haven’t addressed the activity provoking the pain.

Many runners adopt a hyperlordotic position when they are running and even worse, they hinge in a specific segment of their lumbar spine.   They run very upright and may even show excessive vertical oscillation (bounce when they run).

Once you determine that this may be a contributing factor, you need to look at what may be the cause. Typically, it is one of 3 things:

1. Habit: The runner is just too upright and needs to work on a forward lean.  You can cue the the runner to fall through their ankles when they run.  Let them stand still with their feet together and begin to fall forward at their ankles.  They then naturally step forward to keep from actually falling. This is will promote the natural forward lean we are looking for.
2. Hip PROM: Inadequate extension PROM is present, resulting in a compensatory anterior pelvic tilt and hyperlordosis during late stance.
3. Lumbopelvic and Hip Motor Control: Instead of extending the hips through the gluteals, extension occurs through the lumbar spine and no hip extension PROM deficit is present.

You can quickly determine whether this is a problem with PROM or motor control by performing both active and passive hip extension in prone.  I often find a PROM restriction exists, but not always.  Once you treat the passive restriction you need to retrain the new motion with motor control drills.  A simple prone hip extension exercise or quadruped hip extension will often do the trick, but you must focus on promoting hip extension and not anterior pelvic tilting.  Finally, retraining running form to use the new ROM and motor control completes the cycle.  You can use your falling drill at this point.

Physiotherapy intervention for Tennis Elbow:

What is Tennis elbow?

Tennis elbow is a condition caused by inflammation of the tendons that attach the extensor carpi radialis brevis to the outer bony prominence (lateral epicondyle) of the elbow. Certain repetitive movements of the wrist can cause this condition. Tennis elbow can occur in anyone who strains the tendons of the forearm and is not limited to tennis players. Tennis elbow is also called lateral epicondylitis.

Why tennis players getting tennis elbow?

Any activity, including playing tennis, that involves repetitive use of the extensor muscles of the forearm can cause acute or chronic tendinitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow, while attempting One-handed backhand with poor form or technique

Other game players can get tennis elbow?

Yes, You know Sachin Tendulkar, a famous cricketer from India. In 2004, it was happened to him. It was actually a small tear in the origin of muscles at the elbow that runs through to the wrist. In effect, wrist movement caused pain at the elbow. It could happen acutely and immediately, need not have to be over a period of time."

Tennis players what can do to avoid tennis elbow? 

Hold your injured arm out straight, palm down.Use your other hand to hold the back of your injured arm's hand.Press down so your fingers point to the ground.You should feel a light stretch on the top of your forearm. Do not stretch to the point of pain.

Symptoms:

tenderness over the outside of elbow.

Morning stiffness of elbow or persistent aching

Soreness of Forearm muscles

Elbow pain is severe, while holding or grasping the hand.

Call your health care professional or physiotherapist, if the following conditions develop:

• Pain that limits your daily activity
• Pain that lasts despite ice, resting, and over-the-counter anti-inflammatory pain relievers
• Any weakness or numbness in the hand, which may mean you have another type of injury in the wrist or elbow

Are There Home Remedies for Tennis Elbow?

• Home remedies include icing the area for 20 minutes twice a day to help to decrease inflammation and relieve pain. Freezing water in a paper cup and tearing away the top rim as the ice melts is an easy way to use ice. Do not put ice directly on the skin. Wrap it in a towel.
• Rest the sore area to prevent further injury and decrease pain.
• Over-the-counter anti-inflammatory medications such as ibuprofen, asprin or naproxen may help decrease the pain and swelling and help the healing. 

Physiotherapy intervention:

The first steps in treating tennis elbow are reducing inflammation and resting the irritated muscles and tendons. Ice and compression may also help reduce inflammation and pain. Once inflammation subsides, you can begin gentle exercises to strengthen the muscles of the forearm and prevent recurrence.

Most cases of tennis elbow respond to rest, ice, rehab exercises, pain medicine, and counterforce braces. This injury does take from 6 months to 12 months to heal. Patience helps. Surgery is considered as a last resort when all other nonsurgical treatments have failed.

Treatment for Tennis elbow:

• Icing the elbow to reduce pain and swelling. Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone.
• Using an elbow strap to protect the injured tendon from further strain.
• Taking nonsteroidal anti-inflammatory (NSAID's), such as ibuprofen, naproxen, or aspirin, to help with pain and swelling. However, these drugs can cause side effects, such as bleeding and ulcers. You should only use them occasionally, unless your doctor says otherwise, since they may delay healing.
• Performing range of motion exercises to reduce stiffness and increase flexibility. Your doctor may recommend that you do them three to five times a day.
• Getting physiotherapy to strengthen and stretch the muscles. 

  Strengthening Exercises for Tennis Elbow:

      Ball or sock squeeze

     Hold a tennis ball (or a rolled-up sock) in your hand.

Make a fist around the ball (or sock) and squeeze.

Hold for about 6 seconds, then relax for up to 10 seconds.

Repeat 8 to 12 times.

Switch the ball (or sock) to your other hand and do 8 to 12 times.

Wrist deviation

1. Sit so that your arm is supported but your hand hangs off the edge of a flat surface, such as a table.
2. Hold your hand out like you are shaking hands with someone.
3. Move your hand up and down.
4. Repeat this motion 8 to 12 times.
5. Switch arms.
6. Try to do this exercise twice with each hand.

Wrist curls

1. Place your forearm on a table with your hand hanging over the edge of the table, palm up.
2. Place a 1- to 2-pound weight in your hand. This may be a dumbbell, a can of food, or a filled water bottle.
3. Slowly raise and lower the weight while keeping your forearm on the table and palm facing up.
4. Repeat this motion 8 to 12 times.
5. Switch arms, and do steps 1 through 4.
6. Repeat with your hand facing down toward the floor. Switch arms.

Biceps curls

1. Sit leaning forward with your legs slightly spread and your left hand on your left thigh.
2. Place your right elbow on your right thigh, and hold the weight with your forearm horizontal.
3. Slowly curl the weight up and toward your chest.
4. Repeat this motion 8 to 12 times.
5. Switch arms, and do steps 1 through 4.

useful physiotherapy videos for Tennis Elbow:

Physiotherapy role in depression:

One of the biggest things a physical therapist can do for their patients is to be aware of the signs and symptoms of depression and some of the common disorders associated with depression. If the therapist is sensitive to the signs and symptoms of depression they can document it in the plan of care and then notify the physician so the patient can get the appropriate medical treatment, if necessary. Also, because patients with depression may be emotionally unstable, recognizing the signs and symptoms of depression can help you in approaching different situations and then redirecting the patient toward other activities, instructions or more positive topics of conversation.

Exercise has been shown to benefit patients with mild to moderate mood disorders, especially anxiety and depression. When performing aerobic exercise your body releases endorphins from the pituitary gland which are responsible for relieving pain and improving mood. These endorphins can also lower cortisol levels which have been shown to be elevated in patients with depression. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing for more serotonin to remain in the nerve synapse. Exercise can be aerobic or resistive in nature, as both have been shown to be beneficial in a variety of patient types. Anyone with depression can participate in an exercise program no matter how old or young they are, as long as proper supervision is provided. Exercise is an excellent option for treatment when taking anti-depressants is not an option due to their side effects. Depression symptoms can be decreased significantly after just one session but the effects are temporary. An exercise program must be continued on a daily basis to see continued effects. As a person continues to exercise they may experiences changes in their body type which can help to improve self esteem and body image issues they may have been having. Some other benefits of regular physical exercise include:

• reduces/prevents functional declines associated with aging
• maintains/improves cardiovascular function
• aids in weight loss and weight control
• improves function of hormonal, metabolic, neurologic, respiratory, and hemodynamic systems
• alteration of carbohydrate/lipid metabolism results in favorable increase in high-density lipoproteins
• strength training helps to maintain muscle mass and strength
• reduces age-related bone loss; reduction in risk for osteoporosis
• improves flexibility, postural stability, and balance; reduction in risk of falling and associated injuries
• psychological benefits (preserves cognitive function, alleviates symptoms/behaviors of depression, improves self awareness, promotes sense of well-being)
• reduces disease risk factors
• improves functional capacity
• improves immune function
• reduces age-related insulin resistance
• reduces incidence of some cancers
• contributes to social integration
• improves sleep pattern