The 10% Rule

Most of us want to either maintain or increase our fitness level.  Barring time constraints or injury, we strive to do this, some of us on a daily basis.  Usually, this works fine.  Our heart and lungs can usually sustain the increased workload.  When there is a physical limitation, it is usually the musculoskeletal system, not the heart or lungs.  If it is the heart or lungs, that is the topic of another day.  With regard to the musculoskeletal system, the signs and symptoms are aches and pains, and the need to back off or slow down.  This is where the 10% rule comes in.  If you are increasing your physical workload, the body will be much more willing to accomodate it if the increase is at a level of 10%(or less) increase over the previous week.  Keep that in mind when you are increasing your training workload, or recovering from an injury!

Wrist Sprain

Below is an article I wrote which was recently published in the Rochster Democrat and Chronicle. Let us know if you have any questions about this or any other health topic we may be able to address for you.


Sprained Wrist
By
Tony Oliveri, PT, DPT


Falling on the outstretched hand is one of the most common occurrences causing an injury to the wrist. Who hasn’t this happened to?! Of course, other parts of the arm and shoulder can be injured with this type of fall, but a wrist injury is the most likely. Along with a sprain, there is always the possibility of a fracture or dislocation, as there are eight small bones in your wrist. Frequently, the end of the radius bone is fractured. That is why it’s important to have an x-ray of your wrist, should you have lasting pain, swelling, or a loss of mobility after such a fall.

If you do have a sprained wrist, proper care will help to restore it back to normal. Depending on the severity of your sprain, a wrist splint, or even a temporary cast may be needed. This is to assure that the injured ligaments heal in the proper position. In severe cases, surgery may be needed to repair torn ligaments. Once your health professional indicates it is safe to do so, you can gradually decrease use of a splint, if it was needed. In many cases, a splint may not be needed. Your wrist may simply need protection from stressful activities, or wrapping with an elastic bandage or athletic tape.

When pain and swelling are decreased, strengthening and motion exercises can be started. An injury like this often leads to at least temporary loss of strength and mobility, which needs to be restored. A physical therapist can instruct you on the proper exercises to help regain normal function of the wrist, forearm, and hand. For stubborn or more significant injuries, and to speed healing, physical therapy is sometimes recommended. Along with specific exercises, the use of ultrasound, infrared, cold laser and other treatments may be included, to speed the healing process. If physical therapy is recommended, be sure and go to a licensed physical therapist. If not properly cared for, even a sprained wrist can lead to permanent problems.

Tony Oliveri is a physical therapist in private practice in Rochester and Webster,NY

Personal Training

Yes,we do offer personal training! Whether or not you are recovering from an injury, or just trying to get fit. If you don't need physical therapy, or have completed physical therapy after an injury, maybe you need some help achieving your fitness goals. We've been helping people achieve their goals for over twenty years, from fitness enthusiasts to professional athletes. Maybe you just want to "get in shape", or you're preparing for a challenging athletic event or season; if so, let us guide you, or help adjust your training. We have competed in various sports ourselves,as high as the national level, so we know what you are up against! By the way, there are no long term contracts, and you can use our training for as little as one session, if all you need is a minor "tweak". Personal training can be done at our gym, or yours. (The only limitation you may run across is that if you belong to a gym, they may want you to use only their trainers).

Cycling Aches and Pains

Not the bad kind, where a cyclist crashes or gets hit by a car, which we also treat, but this post outlines some of the aches and pains common to bicyclists, both experienced professionals and novices, along with just about anyone in between. The original outline has been presented by Dr. Oliveri to cycling enthusiasts and triathletes in the Rochester, NY area. See below for the outline. Call or e-mail with any questions. Happy riding!


CYCLING INJURIES, ACHES AND
PAINS

Tony Oliveri, PT, DPT

Causes:

• Insufficient warm-up or cool-down
• Sudden changes in training duration or intensity
• Excessive hill work
• Pushing big gears at low RPMs
• Poor bike fit.
• Shoes too tight or too stiff, or too soft!
• Lack of stretching before and after long rides



A sample of problems:

• Ulnar neuropathy: handlebar palsy
• Achilles tendonitis/plantar fasciitis: saddle too low, or foot too far behind the spindle, leading to excessive ankling.
• Anterior knee pain (patello-femoral or tendonitis). 60% of injuries are among experienced cyclists: saddle too low or too far forward.
• ITB pain: caused by pronation, internal tibial torsion, saddle too high.
• Biceps tendonitis: saddle too high or aft. Cleats toe in too much.



Solutions to some of the common
cycling problems

• Gradual increases in duration, frequency, intensity.
• Sufficient warm-up and cool-down.
• Proper bike fit. May include cants or lifts between pedal and shoe.
• Biking shoes instead of sneakers, especially long or hard rides.
• Cycling orthotics.
• Floating pedal systems sometimes kinder to the knees(no loss of power). Sometimes the float needs to be restricted.
• Knee taping or bracing: but tape breaks down and can irritate skin.
• Physical Therapy: exercise modification, manual therapy, ultrasound, infrared, cold laser.

Preventing Falls

Falling is a common cause of injury in all age groups, and a significant health concern, particularly in the elderly. Along with numerous fractures and cases of disability, direct and indirect costs exceed $20 billion annually. With an aging population, fall prevention programs are becoming more popular.

Although older people have a higher risk of falling, many young people also have problems with balance and falling. The main difference between younger and older people is that most younger people are more aware of their surroundings than older folks. Also, fall risks increase in people who have had a stroke or have Parkinson’s disease or another disability. When the body’s balance system has been impaired, falls can result. People who have had recent surgery, and whose blood pressure is not stabilized have a higher risk of falling, as do those on various medications or weak knees or unstable joints.

Fall prevention can take many forms. In many elderly people, it may be necessary to simply get over the fear of falling, through increased, supervised activity. Group exercise programs are great for this! For those with unstable joints or weakness in the lower body, specific strengthening exercises are needed. Care must be taken, however, to not over-stress an unstable joint. That is where a trained professional, such as a physical therapist comes in handy. Special exercises are also very helpful to people whose balance is impaired due to a disease, disability, or illness. Balance exercise programs, as well as addressing medical issues that affect balance have been shown to significantly reduce the occurrence of falls.

At home, there are a few things that can be done to improve your balance safely. It’s important to stand next to a table or countertop while doing these. First, stand straight, without shoes if possible, and try to raise up on your toes 10 to 15 times. If this can be accomplished easily and without pain, then try rocking back and forth from tiptoes to heels and raising the toes off the ground when your heels touch the ground. This can be followed by attempting to hold your balance while standing on just one foot for several seconds. I don’t recommend doing the more advanced moves by yourself, such as balancing on one foot with both eyes closed, until you have become proficient at the easy stuff! It's always wise to learn advanced exercises from an experienced professional, such as a licensed physical therapist.

Exercise & Obesity

Approximately 65% of the U.S. population is overweight, and 30% are considered obese, or significantly overweight. That is nearly twice as many as 20 years ago. Being overweight also increases the risk of other health problems, such as osteoporosis, diabetes, heart disease, stroke, high blood pressure, gall bladder disease, and some forms of cancer. It contributes to arthritis. For many overweight people, starting an exercise program may be very difficult or seem impossible. However, taking the right steps can lead to success

Increased physical activity, along with proper nutrition are recognized as the way to get healthier. Unfortunately, many overweight people turn to fad diets, “miracle” drugs and supplements, or exercise gimmicks that often lead to only temporary weight loss, if anything. The emphasis should be on improving health and fitness rather than just losing weight. Improving fitness can make daily activities easier to accomplish. For people with painful arthritis of the knee, improved fitness has been shown to decrease pain and improve physical function. In addition, people who are more fit don’t get sick as often and recover from injuries faster. These benefits can occur even without weight loss. As fitness improves, it then becomes easier to lose weight. This is because improved fitness increases the ability to perform physical activity. For children, parents should be role models of physical activity. This can be as simple as taking regular walks, or not always trying to find the absolute closest parking spot when shopping!

For individuals who are severely overweight, professional help is available. This is especially beneficial for those who may have other health problems, such as arthritis, diabetes, high blood pressure, and heart disease. Physical therapists have the expertise to individualize safe and effective exercise programs, particularly when the other health problems are present. Nutritionists can make specific recommendations regarding changes in eating habits. These professionals, along with counselors, can also be helpful when it comes to motivation and planning for nutrition and exercise lifestyle changes. With proper guidance, just about anyone can become more fit.

Over Training

In the context of exercise, the term “training” used to refer to an athlete preparing for competition. With the popularity of exercise as a recreational and self-improvement endeavor, many people now talk about their exercise sessions as training sessions. Like a competitive athlete, any avid exerciser can fall victim to the problem of overtraining.

Put simply, overtraining is when the amount of exercise you do exceeds your body’s tolerance. Your repair and healing processes are unable to keep up with the cumulative wear and tear of exercise. Along with too much exercise, other causes include inadequate rest or nutrition, stress, or the wrong combination of exercises.

How do you know when you’ve done too much? There are several signals that your body or mind may provide. One clue, in the early stages is failure to recover from a bout of vigorous exercise within three days. You may experience persistent soreness. Other signs include reduced performance, upper respiratory infections, sugar cravings, headaches, loss of appetite, increased allergy symptoms, swollen lymph glands, and diarrhea or constipation. Another big clue is an elevated resting heart rate, which you can check in the morning. If your morning heart rate is about 10 beats or more higher than usual, it may be a sign of overtraining. Women may experience menstrual irregularities. Mental or psychological symptoms can include apathy, moodiness, depression, irritability, nervousness, poor concentration, or insomnia.

The number one treatment for overtraining is adequate rest. In severe cases, one may have to completely eliminate vigorous exercise for several weeks. In any case, the intensity and amount of exercise must be reduced. Optimal nutrition and hydration(fluid intake) must also be addressed, sometimes with the help of a registered dietitian. Safe resumption of activity often requires the assistance of a health care professional experienced in exercise training, such as a physical therapist or exercise physiologist. With the right help, you can resume your activities and enjoy them once again. In addition, the health care professionals assisting you will help determine if what your are experiencing is not actually another medical condition mimicking overtrianing (get the right diagnosis!).

Winter Fitness

The cold, damp winter months cause many people to slow down. However, exercising in the cold can be safe and invigorating. Staying fit can boost your spirits if you’re prone to winter blues, and keep you slim if you feast too much during the holidays. Consider walking, running, hiking, cross country and downhill skiing, snowshoeing or skating.

Avoidance of outdoor winter exercise stems from fear of the cold. Selecting the proper clothing can help you overcome cold temperatures. The keys to beating the cold are choosing the right types of fabrics and wearing the correct number of layers. Look for fabrics that ‘wick’ moisture away from the skin. These include polyester and polypropylene, among others. Never wear cotton as the layer closest to your skin; it tends to trap moisture against the skin. Pay special attention to fingers, toes, and ears, where there can often be poor blood supply, and your head, from which you can lose up to 50% of your body heat. You can add layers to keep you warm, such as wool or a synthetic. I prefer layers with zippers, so that I can ventilate if I generate a lot of heat. There are several outer layer fabrics available that protect against wind and rain, yet let sweat evaporate. Remember to use light-colored or reflective clothing, especially on moving parts.

Try to overcome mental obstacles to outdoor exercise by setting realistic goals. This can be as simple as trying to maintain fitness, rather than trying to reach higher levels. It's also fine to decrease the volume of exercise you do, such as fewer running miles, during inclement weather. You'll catch up quickly when the weather gets better. Mark time for exercise on your calendar or make ‘dates’ with friends to workout.

If treacherous days prohibit outdoor exercise, you can retreat indoors and use a treadmill, stationary bike, stair climber, weights, elliptical trainer, or a pool. In addition, there are numerous group exercise options to choose from. Some fitness centers even offer short-term memberships during the winter months. Keep active during the colder months and you won’t have so much catching up to do when spring arrives.

Tony Oliveri is president of Oliveri Physical Therapy in Rochester, members of the Olympic Committee National Rehabilitation Network.

Medicines & Exercise

Almost everyone who is recovering from an injury or surgery or fighting a disease will have to take some form of medication. These may be prescription drugs, non-prescription, or both. Since part of the recovery process may include physical therapy or independent exercise, it’s important for you to know the effects and side effects of the medicines you are taking. Medication can influence your participation in physical activities and rehabilitation. If you are undergoing rehabilitation from an injury or surgery, you should inform your physical therapist of all the medication you are taking. The types of drugs that can affect you may include those to control pain and inflammation, heart disease, blood pressure and cholesterol.

Some pain medications can cause you to become groggy or confused, have difficulty breathing, and even lose your balance. The same could occur with cardiac or blood pressure medications. Pills that reduce inflammation may have effects on your blood pressure and blood clotting. Fairly recently, a few anti-inflammatory medications were taken off the market because they caused heart attacks and strokes in some people. Decreased blood flow or increased clotting caused by some drugs could lead to more injuries and even heart attacks. Cholesterol-lowering drugs can sometimes cause muscle soreness or weakness. You will need your physician’s help to determine if certain drugs are actually affecting you in these ways.

Many of the drugs that one can now take do not require a prescription, yet can also have these side effects. Anyone participating in a rigorous activity, such as a marathon, for example, could develop additional problems due to their medication. Many people take anti-inflammatory drugs specifically so that they can participate in a sport. Vigorous or prolonged physical activity can decrease blood flow to the kidneys. Fluid and blood pressure problems can develop if the participant is also taking an anti-inflammatory drug that does the same thing. Older participants, and anyone exercising in high heat and/or humidity are more at risk. Whether you are recovering from an injury, undergoing rehabilitation, or participating in a sport, it’s essential that you discuss any pills you are taking with your physician.

Dr. Oliveri is a licensed physical therapist who owns Oliveri Physical Therapy in Rochester

Exercise & Multiple Sclerosis

For many years, people with multiple sclerosis (MS) have been told to be very careful about exercising. Often, in efforts to maintain strength, they were given limited exercises by medical professionals. The most important advice they received was to avoid letting their body temperature increase, since that can cause temporary worsening of symptoms in some people with MS. That remains good advice. However, recent research reveals that many fitness activities are very helpful for people with MS.

Multiple sclerosis causes problems such as fatigue, weak or spastic muscles, poor balance, heat sensitivity, and depression. Any of those symptoms can lead to physical inactivity, which can lead to more problems or other diseases, like heart disease. People with MS must overcome certain obstacles (such as their symptoms) in order to pursue an active, healthy lifestyle. Up until recently, fitness programs have not been utilized enough in the MS population.

Physical therapy techniques have long played a vital role in the treatment of multiple sclerosis. In many cases, the exercises emphasized mostly the neurological problems that the person was having. These included specific muscle weakness, balance problems, and coordination. A growing number of studies now demonstrate that aerobic and weight training programs are also very helpful for people with multiple sclerosis. As in people without MS, these programs offer fitness and psychological benefits. Participants have noted improvements in their overall quality of life. Some of the easily measured benefits include improved walking speed, endurance and balance, as well as increased strength. Improved coordination and mobility and decreased disability has also been demonstrated.

When entering an aerobic or strength training program, people with MS need to have their specific level of disability addressed. Often, these programs are designed by or in consultation with physical therapists and the client’s physician. Many of the newer programs have begun in hospitals or physical therapy clinics. They have also been set up at traditional fitness facilities or been sent with the client, as a home exercise program. When done properly, exercise programs have been proven to be safe and effective for people with multiple sclerosis.

Therapeutic Light

Surgeons have used lasers in surgery for several years. Now, non-surgical lasers, sometimes referred to as “cold” lasers, and the newer non-laser infrared superluminous diodes(which provide less intense stimulation) are being used to relieve pain and enhance healing. Physical therapists and physicians in Europe and Canada have used these types of devices for the last 25 years, and the Food and Drug Administration (FDA) has recently approved their use in the United States. The new devices approved by the FDA emit infrared light, which is not visible to the naked eye. They also produce very little or no heat (so it’s not a heat treatment, as infrared was in the past). The benefits of this type of treatment are improved circulation, decreased pain, and faster healing.

The FDA has approved the infrared devices for improving blood circulation to the part of the body being treated, to relieve muscle and joint aches, and to decrease muscle spasms. One of the more popular uses is for the relief of wrist and hand pain associated with carpal tunnel syndrome, allowing some people to avoid surgery. In addition, some of the pain and stiffness associated with arthritis can be relieved. Physical therapists and physicians are beginning to see results with many types of joint, muscle and tendon injuries. Professional sports teams are using them to help speed healing of their injured athletes.

Some of the more innovative uses of infrared stimulation is occurring in the treatment of slow-healing wounds such as diabetic ulcers and diabetic neuropathy, which causes numbness and pain, particularly in the feet. The impaired sensation of diabetic neuropathy is the leading cause of diabetic ulcers, which can sometimes lead to amputation. Improving blood circulation in the feet of people with diabetes could help restore sensation. Several recent studies have demonstrated that diabetic patients treated with infrared superluminous diodes experienced improved sensation in their feet, reducing their chances of foot ulcers, and reducing their chances of falling.

These newly available infrared devices offer alternatives to traditional treatments for many painful conditions. They can be used when other treatments have been insufficient or if the patient wants to avoid certain drugs or surgery. They can also be combined with other treatments, depending upon the specific condition and the goals of treatment.

Iontophoresis Treatments

Iontophoresis, a treatment for inflamed joint and muscle problems, is regaining popularity as an alternative to injections and other treatments. The technique, first developed in the mid 1700’s, involves introduction of various medications (in the form of ions) through the skin by means of electricity. Using a low-volt direct electrical current, an ion, acting as an anti-inflammatory or pain-relieving medicine, penetrates the skin into the painful area.

Iontophoresis offers some advantages. It is cost-effective and portable, although the operator must be a licensed health professional. There is often less risk and discomfort than an injection. Unlike pills, it eliminates the absorption and loss of medication into the digestive tract. Also, less medication will have to be handled by the liver, and there is a much lower chance of overdose.

Although iontophoresis has many advantages, it may not be beneficial for everyone. It should not be used on people who have very sensitive skin or are sensitive to any ion that is proposed for treatment. Occasionally, skin irritation, even small blisters can occur on the area where the treatment is applied. In addition, the treatment often requires a series of applications, rather than just one appointment.

This type of treatment has been used successfully to treat tendinitis, bursitis, and arthritis, even gout. It has also been shown to help reduce calcium deposits in muscle,( a condition called myositis ossificans) that sometimes occurs following injury to a muscle. It works best for inflamed tissues that are not too deep below the skin’s surface, since most anti-inflammatory ions can penetrate only about ½ inch. The procedure is most often performed by licensed physical therapists, following referral from your physician. The therapist and physician determine which ion would be most beneficial for each condition. Some physicians also perform intophoresis treatments. If you suffer from one of the conditions mentioned in this article which have not responded adequately to injections or medication, you may want to ask your doctor about iontophoresis.

Osteoporosis in Young Women

Although osteoporosis is most often associated with the aging process, many young women are also at risk of developing this brittle bone disease well before the normal age for menopause. Competitive female athletes can fall into that category due to intense training and low body weight. Referred to as the Female Athlete Triad, the problem includes poor eating habits, menstrual irregularities, and osteoporosis.

In athletic young women, a combination of intense and frequent exercise, insufficient calorie intake, and low body weight can lead to a loss of menstrual periods and eventually osteoporosis. Approximately 20% of active women are unhealthy to the point they stop having regular menstrual periods. Some of the highest risk athletes include endurance runners, dancers, and gymnasts. Along with infrequent or absent menstrual periods, one of the first signs are stress fractures. When body weight decreases due to a combination of intense exercise and low calorie intake, estrogen production can decrease and menstrual periods may become less regular or stop completely. The estrogen levels become so low that it mimics menopause, leading to loss of calcium from the bones, osteoporosis and increased fracture risk. Absence of menstrual periods is linked with almost a three times higher incidence of stress fractures.

Any young woman who develops irregular or absent menstrual periods should consult her physician. If other causes are ruled out, a healthier diet and training modification may be all that is necessary to reverse the problem. Some studies have shown that athletes can restore proper menstrual function in a matter of a few months by simply increasing calorie intake and slightly altering their training, such as adding one day of rest per week, or altering the total amount of exercise. Although weight-bearing exercise is known to help strengthen bones, exercise alone will not eliminate this problem in female athletes. Consulting with a licensed nutritionist is often helpful when attempting to improve eating habits. Modification of training can be assisted by a physical therapist who has experience working with athletes who have this problem. Athletes who have consulted professionals with regard to these issues have not only become healthier, but have also achieved improved athletic performance.

Pulled Muscles

A pulled muscle can occur almost anywhere in the body. Also commonly referred to as a strained muscle, it happens when a muscle is used to a point beyond fatigue, or when it is jerked or stretched too rapidly, or simply worked too hard. Pulled muscles can range from a very small, almost microscopic tear to a large rupture. The pain can also be quite variable.

Many people pull or strain muscles when they become active after a period of inactivity or when they start a new activity. Pulled muscles also commonly occur at the beginning of sports activities. Inactivity causes the muscles to become weak and sometimes tight. Sports coaches are usually aware of the need for their athletes to properly prepare for a new season. In those people who have a tendency to develop tight muscles, stretching is one of the most important aspects of injury prevention. Strengthening exercises, such as weight training, are also good ways to prevent pulled muscles. The key with stretching and strengthening is to increase the activity slowly, so as not to cause an injury while trying to prevent one! Sometimes it is helpful to consult a fitness professional or physical therapist prior to embarking upon a new program.

Treatment of pulled muscles will depend upon the severity of the injury. If the discomfort is mild and does not interfere very much with normal activities, simply turning down your activity level will allow the injury to heal properly. On the other hand, a pulled muscle that is associated with significant pain, swelling, weakness or discoloration(black and blue) should be evaluated by a health care professional. A physician, physical therapist, or athletic trainer can assess the injury and advise you on how to proceed. If professional treatment is needed, is often provided by physical therapists or athletic trainers. Just like the treatment received by professional athletes, it can include ultrasound, electrical muscle stimulation, infrared, and gentle massage; all to help speed the healing process.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome(CTS) is one of today’s more costly workplace medical problems. It can affect anyone, from computer programmers to assembly line workers. You may know of someone who has suffered from this malady or may have experienced symptoms yourself.

The carpal tunnel is a narrow space in your wrist which carries a major nerve (the median nerve) along with tendons that help control your fingers. When inflammation occurs, the tendons swell, fluid increases in the tunnel, and there is increased pressure on the median nerve.

Conditions that can lead to compression of the median nerve include repeated movements, arthritis, diabetes, fluid retention, gout, poorly aligned fractures, chemical imbalances, emotional stress, and even hormonal changes in women. Along with repeated motions, another physical cause can be holding the hand in one position for long periods of time.

People with CTS may experience numbness,weakness, tingling and burning in their fingers and hands. If severe, CTS can force people to undergo surgery to relieve the pressure. In the most extreme, rare cases, a person could be prevented from working at all because their hand function is permanently impaired. Recent studies show that carpal tunnel syndrome is on the rise in some workplaces. Because of this, many employers are turning to physical therapists and other health professionals to help them design programs to prevent CTS. Some of the workplace issues that can be addressed include poor postures, tools, furniture, and equipment. Often included are exercises that people can do at home or at work. In addition, individual work stations may be modified. Specifically, chair type, computer monitor height, and keyboard position may need to be changed. A change in the grip size of a frequently-used tool is often helpful.

While surgery is sometimes necessary, other treatments are often tried first. These include wrist splints, anti-inflammatory medication, and/or injections. In the last two years, infrared light therapy has been used to relieve the symptoms of carpal tunnel syndrome. In 2001, the U.S. Food and Drug Administration approved infrared light for the treatment of carpal tunnel pain. Many of these options are considered prior to surgery or in the event that surgery fails.

Computer Pains

It is not unusual for people to develop various ache and pains from working on (or playing games on) a computer. These can range from hand and wrist pain to headaches, neck ache and backache. Minor changes to a computer user’s furniture or posture can go a long way toward preventing or alleviating pain.

Often, when someone has been concentrating on their computer work, he or she develops a “forward head” posture. Instead of the face, neck and chest being lined up, the person’s head is leaning in toward the monitor. This can be caused by eye fatigue, neck fatigue, or a monitor that is not lined up properly to fit the user. For most people, the best position to place a monitor is so that the user is looking down slightly at it, rather than looking up or having to look way down to see what is on the screen. If eye fatigue or squinting is frequent, a visit to the eye doctor is in order. It’s important to try and maintain an upright posture and take frequent stretch breaks before pain sets in. If not corrected, the forward head posture can lead to severe neck and shoulder pain or headaches.

Another cause of computer-user pain is unsupported wrists. When using a keyboard or mouse with nothing to rest the wrist on, the neck and shoulder muscles are being used to hold the arms steady. Eventually, this can lead to significant neck and shoulder pain. The solution for that is to have a few inches of table top (or keyboard shelf) between you and the keyboard, so that the wrists have something to lean on. Also, the keyboard shelf or table should not be too high, leading to excessive bending of the elbows.

Prolonged computer use requires a properly fitting chair to help prevent low back pain. A good fitting chair will support the lower back and not require the user to slouch or reach in order to get their feet on the floor (or stool). Since prolonged sitting can cause back pain, even in the best chair, getting up frequently to stretch or just relieve pressure can be very beneficial. If these minor aches and pains are ignored, they can become chronic problems which require medical attention.

Kids & Backpacks

Wearing or bringing backpacks to school is a way of life for most students. Backpacks have become one of the most convenient ways to carry books, supplies, lunch, and snacks. Unfortunately, an overloaded or improperly worn backpack can lead to back, neck or shoulder problems.

A study at Simmons College in Boston found that 55% of the children surveyed carried backpack loads heavier than 15% of their body weight, the maximum safe weight for children recommended by most experts. In that study, one-third of the children reported pain that had caused them to visit a doctor, miss school, or abstain from physical activity, such as gym class. Children are at risk of injury due to the fact that their bones are not fully developed. Warning signs that a backpack may be too heavy include pain or a posture that changes while wearing the pack, struggling to put it on or take it off, and tingling or numbness.

An injury can develop when a child uses bad postures in order to accommodate the heavy load. The postures can include arching the back excessively, bending forward or leaning to one side. The poor postures, especially under a heavy load, can cause improper spinal alignment, hampering the function of the disks and muscles of the back. The shock-absorbing ability of the disks is affected, and the muscles can become strained and fatigued. This makes the neck, shoulders and back more apt to be injured. The fatigue and posture changes can occur with backpack loads greater than 10% of body weight.


Regular, daily users of backpacks should follow these guidelines:

• Do not pack more than 10 to 15% of bodyweight in the backpack.

• Wear both shoulder straps. Wearing one strap will shift all the weight to one side.

• The backpack should rest evenly in the middle of the back, rather than extending below the lower back. This is done by adjusting the shoulder straps, while still allowing the backpack to be easily put on and taken off.

• Each night, remove articles that will not be needed the next day.

• If heavy loads are frequently carried, choose a backpack with the following features: padded and contoured shoulder straps, padded back, multiple compartments.

Backpack use should be looked at in any child who develops back, shoulder, or neck pain with no known injury.

TMJ (Jaw) Pain

Pain related to the joints of the jaw is referred to as temporomandibular joint (TMJ) pain or dysfunction (TMD). The problem is often treated by dentists, oral surgeons and physical therapists. Symptoms may include pain in the head, neck or face and problems such as inability to fully open or close the mouth, difficulty chewing, or locking of the jaw. Many individuals with this problem experience clicking, popping, or cracking when opening or closing their mouth. In some cases, the jaw deviates to one side when the mouth is opened or closed. Some individuals have ringing in their ears or the sensation that their ears are “stuffed”.

Dentists will address TMJ by correcting tooth problems, such as how the top and bottom teeth fit together: occlusion. They also may fit the person for a night splint. In some cases, oral surgery is required. Often, while or after dental problems have been addressed, the sufferer may be sent to a physical therapist. Physical therapy can include exercises, stretching, posture correction, and various treatments to reduce pain.

Physical therapy treatment selection is aided by a determination of the cause of the problem. If the person has had jaw surgery, physical therapy will address regaining normal strength and flexibility for chewing and speaking. Often, people with TMJ problems will have neck pain. Regaining normal neck flexibility and posture is a frequent goal in these cases. Physical therapists may perform stretching to the neck, and sometimes the jaw muscles. One of the most popular treatments for TMJ is a home exercise program. In a home program, the patient is taught exercises which help to restore a normal resting position of the head, neck, jaw and upper shoulder girdle. Other exercises help to normalize opening and closing of the mouth. To reduce or eliminate pain, various treatments, such as infrared, ultrasound, electrical stimulation, heat, ice or massage may be given.

Tennis Elbow

Pain on the outer side of the elbow is fairly common and is often referred to as “tennis elbow”. It can interfere with a person’s work, home life, and recreation. Of course, playing tennis is not necessary to cause the ailment.

The cause of tennis elbow is usually overuse, although trauma, such as banging the elbow against something can also cause it. Inflammation develops in muscles and tendons on the outer side of the forearm, where they attach to a bone in the elbow. In addition to the elbow, the pain can also be felt along those forearm muscles. Pain will often increase as the arm is used, even with only simple daily activities, such as brushing one’s teeth or opening doorknobs. Severe cases will cause almost constant pain or pain with simply extending the wrist or fingers.

Treatment consists of resting the arm, reducing inflammation, and eventually strengthening the muscles and tendons involved. If simply avoiding activity is not enough, a splint or cast may be prescribed. Many people find that a tennis elbow strap, available at many sporting goods stores or pharmacies, may offer temporary relief. Anti-inflammatory medicine is sometimes helpful. In physical therapy and sports medicine clinics, ultrasound and electrical muscle stimulation are often used. Ultrasound has been shown to relieve pain and inflammation, and speed the healing process. Electrical muscle stimulation can also relieve pain, although it does not replace exercise for the purpose of strengthening. Cold lasers (not surgical lasers) and superluminous infrared diode treatments are gaining popularity and have been adopted by professional sports teams and the military. The final step in recovery is a strengthening program designed for the elbow and forearm muscles. Great care must be taken, to assure that the prescribed exercises do not actually worsen the condition. This is where an experienced physical therapist come in handy. In extreme cases that do not respond to all of those treatments, surgery is sometimes performed to remove scar tissue that has formed.

Tony Oliveri is a licensed physical therapist who owns Oliveri Physical Therapy and Sports Training in Rochester

Rotator Cuff Injuries

Although many people equate rotator cuff injuries with baseball players, they happen to occur fairly frequently in the general population. In my clinic, we’ve seen everyone from high school baseball pitchers to 85 year old never-athletes with this problem. There are many other shoulder injuries that could appear coincidentally or even mask a rotator cuff injury. These include bruises, separations, and bursitis, just name a few. If you have a shoulder pain or weakness that does not improve after a week, you should report it to a health care professional. Special tests are sometimes needed to confirm rotator cuff tears.

What is a rotator cuff, anyway? Rotator cuff refers to a group of four muscles in the shoulder which help to stabilize it and participate in almost all shoulder and upper arm movements. A loose or “subluxing” shoulder can irritate the rotator cuff, but not necessarily tear it. Sudden or violent movements of the arm, especially behind the back or overhead, can strain or tear it. That’s why baseball pitchers are among those who frequently injure their rotator cuff. Overuse, or repetitive “micro-trauma” can also build up to gradually cause a tear. This can occur by something as innocuous as simply moving ones arm repeatedly while sitting at a desk to something as vigorous as swinging a golf club. The movements affected by a rotator cuff strain can include inward and outward rotation of the arm, as well as lifting the arm forward or sideways. Often, lifting the arm out to the side is the most painful movement. In a severe injury, the person will barely be able to lift up his arm.

Treatment: Once a rotator cuff injury has been diagnosed, various things can be done. The physician may require you to wear a sling for a few weeks (if the injury is bad enough), to allow the injured tissues to rest and begin healing. You may also be referred to a physical therapist. Physical therapy can include therapeutic ultrasound, electrical muscle stimulation, infrared, cold laser, ice, and special rehabilitation exercises. It is essential that the exercises be specific to the injury, so as to strengthen what is weak, while not irritating what is already inflamed. In severe cases, surgery is performed by an orthopedic surgeon. After surgery, physical therapy is often prescribed, to help regain strength and range of motion in a safe and effective manner.

Hamstring Injuries

Injured hamstrings are seen quite often in both athletic and non-athletic individuals. Often referred to as a “pulled hamstring”, it is actually a strained or partially torn muscle. The hamstrings are of course the large group of muscles in the back of your thigh. These long muscles have their attachments at the base of the buttock and behind the knee, at the tibia and fibula bones. They have two main functions: to bend the knee and to extend the thigh from a position in front of the body to a position in line with or behind the torso, such as when walking, running, getting out of a chair, or climbing stairs.

An injury to the hamstring can occur with almost any activity which requires the use of your legs: from all the activities mentioned above to dancing or even a simple slip on the ice. These strains can range from a very small tear to a large rupture in the middle of the muscle or off an attachment to one of the bones. Why are hamstrings injured so often? To function optimally, hamstrings need to be somewhat flexible. However, sedentary activities such as sitting can cause these muscles to become tight. Stretching thus becomes the most important aspect of injury prevention. One of the simplest stretches for the hamstrings is to lie on your back, beginning with both knees bent; hold the back of one thigh with both hands and attempt to straighten your leg(foot pointing toward ceiling) for 15 to 30 seconds. Repeat 3 or 4 times on each thigh.

Treatment of hamstring injuries is dependent upon the extent of damage sustained. Minor strains will require some level of activity limitation, as well as careful stretching. Ice applications, of approximately 20 minutes each, are often helpful early on, as is use of anti-inflammatory medication. If your injury takes more than a few days to respond to your own treatment, check with a health care professional: you don’t want to cause more damage as you “treat” yourself. Severe hamstring injuries may even require crutches. Once the acute phase (pain!) has subsided, gentle strengthening and stretching exercises can begin gradually. Other modes of treatment, often performed by physical therapists or certified athletic trainers, include ultrasound and electrical muscle stimulation, both of which have been shown to speed healing. In addition, physical therapists, athletic trainers, and massage therapists often provide special massage techniques to the injured muscle; again speeding healing and breaking up scar tissue, or preventing it from forming. Unfortunately, some hamstring injuries heal very slowly, and patience is required.

Iliotibial Band Syndrome

The iliotibial band(ITB) is a thickening of tissue under the skin of your thigh, extending from the outside of the hip to just below the outside of the knee. In active people, such as runners, cyclists, and in-line skaters, this structure can cause lateral knee pain, with no apparent injury. Due to the fact that no trauma has occurred, many individuals struggle with this problem for long periods of time.

With every bend and straightening of the knee, the ITB rubs over the outside of the knee. In the vast majority of cases, this never causes a problem. However, certain situations can lead to pain. Some people, because of leg alignment, tightness in the ITB, muscle imbalances, and even foot problems will develop knee or thigh pain related to their ITB. Muscle imbalances occur when one group of muscles become either over or under-developed. Running on a banked track or on the shoulder of a road can cause stretching of the band against the outside of the knee. The band itself, and/or the outside of the knee can become irritated. In addition, inadequate warm-up and cool-down may also overwork the iliotibial band.

The pain associated with an ITB problem may develop gradually, or “come out of nowhere”. Most often, the pain is just above the outer side of the knee, but it may also be present all along the outer side of the thigh. Sometimes swelling is present at the spot where the band rubs over the outer side of the knee. The pain is usually not constant, but brought on by certain activities or positions.

Treatment of ITB problems often includes stretching of the band and its associated muscles. Runners may have to decrease their mileage or change their running route, to avoid too much running on the same banked surface. Cyclists may need to temporarily change their seat height. Ice and anti-inflammatory medication may be used to relieve symptoms. Once the problem is diagnosed, ultrasound, infrared or cold laser and advanced stretching techniques are often applied by physical therapists or athletic trainers. In addition, motion-control running shoes or a shoe orthotic may be recommended, to level out how the foot hits the ground. In many cases, we have found success by teaching specific exercises to improve strength from the hip down to the foot, thus creating greater stability and eventually eliminating the pain completely. In very rare cases, surgery(by an orthopedic surgeon) may be needed to solve this problem.

ACL Rehabilitation

The torn anterior cruciate ligament (ACL) of the knee is one of the most common season-ending sports injuries. This injury has received a lot of press recently, particularly regarding the numerous female athletes who have sustained it. Fairport’s Caitlyn Howe and WNBA star Sheryl Swoopes are just two of the most recent athletes to sustain the injury. Regardless of whether the injury affects a male or female, rehabilitation can be tedious and last from 6 to 12 months.

Although many athletes undergo surgical reconstruction or repair of the torn ACL, there are some athletes who are able to participate in their sport without a surgical repair. This depends upon several factors, including the type of tear they sustain, which other structures are injured, and the amount of stability provided by other knee ligaments, cartilage and muscles within the same knee. When this injury occurs, the knee usually collapses and there is considerable pain and swelling. Anyone suffering this injury can usually sense a certain amount of instability in his/her own knee.. The knee will feel somewhat loose, as if it is slipping or even give out at times. With the help of orthopaedic surgeons and physical therapists, athletes can make a decision regarding surgery. If the knee is very unstable, surgery will usually restore enough stability so that an athlete can return to their sport.

Following either surgical or non-surgical treatment (a prescribed period of rest and/or bracing), the injured knee must be rehabilitated. The goals of rehabilitation are to restore strength, motion, and functional ability, and to eliminate pain, swelling and instability. It is here where traditional strengthening exercises and specialized rehabilitation are merged. Traditional strengthening exercises will restore most of the strength to the muscles around the knee. Specialized stability exercises, usually taught under the supervision of a physical therapist, involve various hopping, pivoting, stepping and jumping maneuvers. This phase of rehabilitation is sometimes referred to as functional rehab, since it mimics things that the injured person may wish to be able to do without their knee giving out. The variety of functional rehab exercises used will depend upon what activity the injured individual is striving to return to. Some of the exercises are so helpful that many non-injured athletes are now using them to enhance performance and prevent injuries.

Tony Oliveri is a licensed physical therapist and owns Oliveri Physical Therapy and Sports Training in Rochester.

Get Hip to Your Knees

Anterior knee pain, or “patello-femoral” pain is one of the most common orthopedic problems in adolescents and young adults. It can occur in more than 25% of people in those age groups. It is even more common in females than in males. Since there is often no injury that precedes the pain, the diagnosis and treatment is difficult to determine. The pain can come and go for years if the cause remains undetermined.

Recent research has determined that many individuals with patello-femoral pain also have weak hip muscles. To investigate the theory that hip weakness may lead to knee pain, researchers at the University of Southern California placed individuals with patello-femoral pain on a physical therapy program to strengthen their hips. Patients on the program experienced significant reduction in knee pain. A few of the exercises that can be done at home include sideways leg raises, as well as balancing on one foot, while not allowing the hip to sag to either side.

Along with identifying weak hip muscles, physical therapists and physicians are often able to identify abnormal movement of the thigh or lower leg which may be putting excessive stress on the patello-femoral joint (or front of the knee). Those problems can be addressed with individually-tailored exercises to correct the movement, strengthen the muscles performing the movement, and reduce knee pain. Those type of exercises are often very successful.

Other treatments that are done for anterior knee pain include quadriceps strengthening, taping of the kneecap, bracing, stretching, and electrical muscle stimulation. In addition, arch supports for the feet are sometimes prescribed to control foot movement and improve leg alignment and relieve knee pain. The emphasis on treatment of body parts and movements connected to the knee has decreased the frequency of surgery for this particular knee problem.

Knee Pain in Young Athletes

Young athletes are susceptible to almost all of the knee injuries seen in adults, but two of the more common conditions that affect teens and pre-teens are Osgood-Schlatter disease and patello-femoral (kneecap) pain.

Because youngsters’ muscles, bones and joints are not fully developed, it’s important that symptoms be evaluated by a professional to avoid prolonged discomfort, a more severe injury, or even unnecessary removal from an activity.

Osgood-Schlatter disease is the most common cause of knee pain in young athletes, particularly boys. It's caused by repetitive tension from vigorous knee movements and has a tell-tale tender bump just below the kneecap. It is aggravated by running, jumping, kneeling, and squatting. The problem resolves when growth is completed in that part of the bone, around age 15. There is no need to completely restrict activity with this condition, but some cases will require a partial decrease in painful activity, anti-inflammatory medicine, ice and flexibility exercises. It is essential to use proper technique when strengthening the legs, to minimize pain.

Another area of pain in youngsters is the patello-femoral joint, or kneecap area.(it’s not just the kneecap, but also the area immediately surrounding it) The pain can be caused by a slight misalignment between the kneecap and the rest of the knee. If misalignment is the cause, treatment can include taping, temporary bracing and a physical therapy program of specific exercises to stretch tight muscles and strengthen weak muscles around the kneecap. Sometimes, even arch supports will help, if a foot problem is causing the knee to be misaligned. It is one of the most frequently seen problems by physical therapists.

There are other causes of knee pain in young people that require the expertise of a professional health care team for proper diagnosis and treatment. These conditions include detached fragments of bone and/or cartilage, which are not preceded by an injury. If a young person’s knee problem does not respond to simple measures such as ice, compression, elevation and decreased activity, a visit to the doctor is definitely in order.

Tony Oliveri is a licensed physical therapist who owns Oliveri Physical Therapy and Sports Training in Rochester.

Knee Pain

Knee pain is one of the most common complaints among both athletes and non-athletes. Sources of knee pain include ligament sprains, muscle strains, bruises, and even fractures. In addition, inflammation in the form of arthritis, tendinitis, or bursitis may be the culprit. Quite frequently, a person can develop knee pain without recalling an actual injury.

If you develop knee pain and don’t know what it is, many possibilities exist. Tendinitis refers to inflammation of a tendon, the area where a muscle attaches to bone. Bursitis is inflammation of the small fluid sacs which help to lubricate joints, while arthritis refers to inflammation of the surfaces of bones which are normally smooth and glide painlessly upon one another during movement. There are numerous possible causes for all of these forms of inflammation, including trauma, overuse, strain, and the various forms of arthritis which are too numerous to mention here.

One of the more commonly reported maladies of the knee is referred to as anterior knee pain, or “patellofemoral” pain. This can be caused by a slight misalignment between the kneecap (patella) and the rest of the knee. Often, this pain develops following a change in activity (or sport) or even from wearing a worn out pair of shoes for too long! The trick to eliminating the pain, is, of course, finding the cause. If the cause is not obvious or the pain severe, you should contact a health care professional for assistance.

Self-treatment for minor knee discomfort includes ice (20 minutes at a time),decreased activity, and application of over-the counter anti-inflammatory cremes. If you use an elastic knee support, it should not be applied too tightly or overnight: you’ll end up with a swollen foot or ankle due to compression of blood vessels behind your knee. Medical treatment could involve drugs, injections, and sometimes surgery. Physical therapy treatment can include taping, temporary bracing, ultrasound, infrared cold laser and instruction in specific exercises to stretch tight muscles and strengthen weak muscles around your knee. In addition, electrical stimulation to some of the knee muscles has been shown to help in many cases.

Shin Splints

Shin splints, or lower leg pain is a common ailment, particularly in runners. It can occur in seasoned runners as well as beginners or even non-runners. The pain appears when the physical stress of running(or walking) exceeds the body’s ability to tolerate it.

The key symptom is an ache , throb, or pulling sensation in one or both legs, between the ankle and knee. Pain can be present either on the front or inner side of the shin. Often, there is tenderness when pressure is applied to the shin bone(tibia). These symptoms usually occur after running or other weight-bearing exercise. However, in some cases the pain may actually go away while exercising, once the muscles are warmed up. This can lead a person to ignore the symptoms, only to worsen gradually.

Shin splints can be caused by muscular imbalances, insufficient shock absorption, increasing running mileage too quickly, or excessive pronation(flattening and turning in) of the foot. Muscle imbalances occur when one group of muscles is either too tight or too weak in relation to the opposing group. An example is the calf muscles being too tight and the frontal shin muscles being too weak. A physical therapist can evaluate a muscle imbalance and prescribe corrective exercises. Insufficient shock absorption can be related to a combination of muscle imbalance, a hard running surface, or shoes that are worn out, as well as excessive pronation. It is important not to exceed the useful life of your running shoes when it comes to shock absorption and overall support. Experienced running shoe salespeople can help you make that determination.

Minor cases of shin splints can be self-treated with a combination of rest or cutting back on activity and in some cases, anti-inflammatory medicine. Questions about medication can be answered by a physician. Application of ice after activity is often helpful. Runners or walkers can decrease their mileage and avoid hard surfaces, or get better cushioning. Suspect pronation as a cause of the problem if the inside heel of the shoe wears out more quickly than the outside. Supportive, inexpensive shoe inserts are often enough to alleviate shin splints. There is now a leg support available that may help some individuals. In extreme cases, custom-fitted orthotic devices may be needed. Persistant problems can be addressed by professionals who deal with the lower leg and foot, such as podiatrists, sportsmedicine physicians, and physical therapists.

If ignored, shin splints can develop into a stress fracture, a much more serious problem.

Achilles Tendon Injuries

Pain in the Achilles tendon is common in both active individuals and those who exercise very little. So common, and been around so long that it is mentioned in Greek mythology! The tendon is located in the back of the ankle, acting as the attachment of the calf muscles to the heel bone. Like many other tendon problems, an injury here can stem from overuse or degeneration (the gradual breakdown of connective tissue).

With tendinitis, the feeling may be that of a mild burning, prickly sensation or dull ache in the Achilles tendon, about 1 to three inches above the heel bone. That part of the tendon is susceptible to injury or degeneration due to a poor blood supply. As the problem worsens, the pain may be described as a shooting, stabbing sensation, especially during physical activity. A crackling sensation may sometimes be felt while rubbing the tendon with fingers, indicating inflammatory fluid is probably present.

If the tendon becomes weak, a partial or complete tear(rupture) can occur. At that point, the person may feel a sudden snap or pop, sometimes believing that someone has kicked them. Sometimes, there is very little pain, but swelling develops. A torn Achilles will cause obvious weakness when attempting to stand on ones toes or “push off” with the foot.

Achilles tendon irritation can be caused by something as simple as the back of the shoe rubbing against it. On the other hand, damage can be caused by repetitive overstretching while running or walking. If flexibility and conditioning in that part of the body is not optimal, the tendon gradually loses its ability to tolerate the stress of body weight with each step. The best prevention is a flexibility and strengthening program for the calf and ankle area. Like most overuse injuries, a gradual increase in training volume and intensity is also one of the best ways to "stay out of trouble". Try not to increase volume or intensity by more than 10% per week. Your heart and lungs may be able to take it, but your achilles may yell at you!

Treatment for Achilles tendon problems begins with self-care. This can include gentle stretching, ice application, and use of over-the-counter anti-inflammatory medication. Some practitioners even recommend the latest dietary supplement used for arthritis: glucosamine. Professional care should be sought if the symptoms do not resolve after two weeks, or if an obvious, persistent limp is present. Your health care professionals may prescribe special exercises, rest, physical therapy, and possibly medication. Other treatments include heel lifts, shoe orthotics, and night splints. Surgery may be required if excessive scar tissue has formed or if a complete rupture is present. After that, a gradual program of rehabilitation would be needed.

Tony Oliveri, M.S.,P.T.

Ankle Sprains

Sprained ankles happen to be one of the most common injuries among both athletes and non-athletes. The amount of movement that takes place at the ankle, coupled with numerous opportunities for missteps or awkward positions makes the area very vulnerable.

Sprains can occur on either side of the ankle, but the outer (lateral) side is injured most frequently. An ankle sprain occurs when the foot is turned excessively and abruptly enough to tear or overly stretch ligaments around the joint. Occasionally, the sprain can be severe enough to cause a fracture of bone that is attached to one of the ligaments (referred to as an avulsion). The severity of an ankle sprain can often be initially determined by the symptoms. Mild sprains will usually cause only mild discomfort and swelling, and very little or no swelling. More severe sprains will cause limping, greater swelling and often bruising within several hours.

Treatment of an ankle sprain will of course depend upon the severity of injury. With most ankle sprains, the initial treatment is often referred to as RICE: rest, ice, compression, elevation; which are meant to promote healing (rest), and reduce pain and swelling. Protect the skin from cold injury by using a small cloth between the skin and ice, or apply ice massage after proper instructions by a health care professional. Ice applications should not last more than about 20 minutes, but can be repeated frequently. Compression can be applied using an elastic wrap or an air splint. Care must be taken, to avoid too much compression, leading to swelling or numbness in the foot. Mild sprains will often require only a few days of home treatment, followed by a gradual return to usual activities.

Moderate to severe sprains will not respond quickly to the treatment described above and will exhibit more pain and swelling than mild sprains. Any sprain that does not respond within a few days to the RICE treatment or leads to persistent limping should be evaluated by a professional. X-rays may have to be done if a fracture or severe ligament damage is suspected. Along with RICE treatment, crutches and/or a cast may be needed. In very severe cases, surgical repair may be required. Full recovery from severe or persistent ankle sprains often involves strengthening, balance, and carefully prescribed agility exercises, to regain normal function and prevent reinjury. At Oliveri Physical Therapy, we provide all of the exercises needed to properly rehabilitate injured ankles. In addition, we provide modalities such as ultrasound, electrical stimulation, and infrared energy to promote and speed healing.


Tony Oliveri is a licensed physical therapist and owns Oliveri Physical Therapy and Sports Training in Rochester.

Back Pain

By Tony Oliveri, DPT


Back pain is one of the most common reasons for visits to the physician or physical therapist. The causes of back pain are too numerous to list here, but most cases are caused by poor posture, repetitive minor strains or awkward movements or positions.

Doing an activity you are not accustomed to can easily cause back pain, even in a very fit person. A fair weather example is gardening, or yard work. Bending or stooping repetitively, or for prolonged periods often leads to back pain. Repetitively rotating, even slightly, such as while raking can also lead to back pain. It is the repetitive nature of the activity, not the force, that generally causes the back pain. Stretching prior to getting into the activity, just as in sports, can help prevent problems.

Apparantly simple activities such as those mentioned above can lead to back pain either because the movement is unfamiliar (you are “out of shape for it”), or the position itself causes muscle or joint stiffness. Since muscle and joints thrive on movement, holding a position or posture for a prolonged period of time leads to stiffness and pain. Learn to interrupt the activity, even briefly, to avoid the stiffness. A non-activity that can lead to back pain is slouching. When slouching becomes a habit, the relaxed muscles become weak, and other muscles become tight. Eventually, back pain can develop, since the muscles are not holding the vertebrae of the spine in proper alignment.

Although you may not be able to totally prevent it, you can reduce the frequency, duration, and intensity of low back pain. Along with many types of pain-relieving treatments, physical therapists can provide instructions on improving posture, proper lifting techniques, and specific exercises and stretches to decrease and help prevent back pain. When the back pain is associated with sciatica, or leg pain, a careful evaluation by a health care professional should be done prior to initiating back exercises. The wrong exercises can easily make the problem worse. Regular exercise, such as walking, swimming, and weight training has also been shown to reduce the occurrence of back pain.