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A Today Show segment on pain and injuries aired today, 10/22/2014.  The segment started out well with the anchors stating, “…it turns out that pain from years back are not only likely to reappear later in life but can cause even more damage if you ignore them.”

I’m thinking to myself: Ok, sounds good. All true. This can be a pretty good segment.  This is information that is reaching millions of people, and usually this information is poor and misleading.   So I get more interested when something sounds like it could be valuable and correct.

The Today Show enlisted Lynya Floyd, Health Direct at Family Circle Magazine (@LynyaFloyd) and Natalie Azar, MD, Clinical Assistant Professor in Department of Medicine at NYU Langone Medical Center (@DrNatalieTV) to discuss the topic.

Lynya Floyd starts off by stating that old injuries reoccur all of the time.  “Injuries impact everyone…when it happens to you, it’s the most important thing in the world…when injuries are gone, they shouldn’t be forgotten because they can sneak up on you, and they can come back”

  1. 1. Don’t ignore an injury act on it.   When you have pain, it’s your body telling you that something is wrong and do something about it.
  2. 2. See the proper authorities. Talk to your doctor. Talk to your physical therapist (good stuff).
  3. 3. Don’t forget about it. Make sure that your body stays strong in the future and that the injury doesn’t come back to you.

So I’m thinking, Ok, still some pretty solid advice.  Though, they are a little vague on saying make sure the body stays strong.  I will just add, that it’s important to make sure that you are doing the movements and exercises correctly.  You should be performing an exercise plan that is tailored towards your needs, by a qualified and skilled professional – whether it’s strength and conditioning coach or a physical therapist.

The segment goes on.  This is where the video picks up to discuss injuries in 3 areas: shoulder, knee, and low back; with 3 specific diagnosis: rotator cuff, ACL, and herniated disc, respectively.  By the way, theses are 3 of the most common areas of the body treated by physical therapists.

The Truth about Low Back Pain and Herniated Discs:

 

Dr. Natalie Azar starts to discuss low back pain and they decide to talk about the herniated disc in the lumbar spine, or low back area.  In my opinion, the herniated disc is one of the most over-diagnosed and miss-diagnosed causes of low back pain or injury.  People come in with this diagnosis because an MRI showed some sort of a protrusion of a disc in the lumbar spine, yet there are way more glaring issues at hand.

9 times out of 10, the disc itself is not the issue.  Most of the people, who come in with this diagnosis, have other issues that are causing their pain.  Maybe their disc is hitting their nerve and causing pain, or maybe their other soft tissue structures (fascia, muscle, etc) in their low back, hip, buttocks, and/or leg is hitting the nerve and causing pain.  I don’t have x-ray vision to see what exactly is happening deep in the body when they are moving or in a certain position.

However, what I can see, is how they are moving.  Their movement and muscle activation patterns are always very poor.   For example, over activating the low back muscles instead of the buttock muscles when they bend and stand.  These are the underlying issues that are causing the pain and symptoms.  Whether it’s a vertebrae-disc-nerve issue or a soft tissue-nerve issue, the movement patterns are almost always the culprit.  If these issues are not addressed, then the issue will either come back quickly, will never go away, or will get worse.

Dr. Azar’s treatments for the herniated disc included: topical or oral anti-inflammatory, a pain medicine patch, or surgery for worst-case scenarios.  I agree that surgery is for worst-case scenarios for people with true disc herniations.  However, none of these “treatments” address the underlying cause of the pain and problems, the way the person moves.  This is why so many people still have back pain.   She did not mention physical therapy as an option at all.  That is what millions of people got from this, more bad advice.  Good physical therapy should be the number 1 option.

Rotator Cuff and the Shoulder:

Dr. Azar then goes on to discuss the rotator cuff.  To better describe the rotator cuff:  The rotator cuff is made of up 4 muscles that work to keep the head of the humerus (part of the arm bone that meets up with the scapula, or shoulder blade, to make up bony configure the shoulder joint) in the best possible position so that the humerus can easily pivot on the scapula is it moves.  This allows for the other muscles around the shoulder to act as efficiently and strongly as possible.  The rotator cuff does have involvement in moving the arm, but keeping the head of the humerus in the correct pivoting point on the scapula is the most important role.

Not all pain in the shoulder is caused by the rotator cuff.  Not all tears in the rotator cuff require surgery, including full thickness tears.  A lot of pain that occurs in the shoulder, similar to the low back, is from the muscles that make up the shoulder. For example, the biceps and pec tendons are almost always irritated and inflamed, causing a lot of pain.   A lot of shoulder pain and injuries can be treated without surgery, by going to a good physical therapist.  Again, it comes down to proper movement and muscle activation patterns.

Can Physical Therapy for Rotator Cuff Tears Prevent Surgery? – Mike Reinold

More info on the Rotator Cuff – Mike Reinold

Pain or injury may be caused by specific event, but it may not.  You don’t have pain, until you do.  It is likely that your movement patterns over the years have been slowly wearing on specific structures in your joints, whether it’s the shoulder, knee, back, hip, etc.  Then one day, something around that joint simply starts to give and you get tears and/or pain.  You could be doing the same movement thousands of times without a noticeable pain or issue, however if you were doing it a manor where something was just a little bit off, eventually it’s going to break down.

ACL and the Knee:

 

This is what I believe happens with a lot of non-contact ACL tears.  These athletes are performing repetitive movements with poor control and movement patterns throughout their trunk, hips/pelvis down to their feet.  The poor control and movement patterns leads to increased stress on the ACL and other soft tissue structures around the knee. The muscles aren’t in the position to act as efficiently and strongly as possible, and on that one movement, the ACL finally gives out.  Now, there are other factors and other causes, this is just one example.

Which brings us the last topic of the Today Show segment, the ACL.  Lynya Floyd states that you have to make sure you keep the muscles around the knee strong.  Which is a fine statement, but it is just not that simple.  It’s not only about your quadriceps, hamstring, and calf muscles. It’s also about mobility, movement patterns, muscle activation patterns, neuromuscular control, and strength of your foot/ankle, hips, gluts, abdominals, low back, thoracic spine.  There is much more involved then that simple statement.

Go to a good physical therapist or strength and conditioning coach and get an exercise program that is made specifically for you and what you need.

What a good physical therapist, strength and conditioning coach, and fitness trainer actually is, is a topic for another discussion.

I know that there is limited time on these segments, and I am not blaming anyone because I don’t know. But at least give out good, solid information that people can learn from and not just put them back on a path where they will have more pain, injuries, and issues.

– Shaun Logan, PT, DPT
Movement by Logan…more than your physical