Our imaging technologies have made tremendous improvements in their ability to detect abnormalities in our body that are often attributed to low back pain.  In reality, these positive findings may or may not be related to our current low back pain symptoms including stiffness, or giving way.  We have seen improvements in the sensitivity of these tests where we are able to detect individuals with the condition of interest such as a lumbar disc bulging, stenosis, arthritis, or degenerative disc disease, but with increased sensitivity comes limitations.  In particular, these tests ..read more

The use of low back injections is often utilized for patients with low back pain and nerve pain (radicular pain) and/or leg numbness, pins and needles, or nerve root weakness (radiculopathy). In an older adult these symptoms may be due to a narrowing of the canals in which the low back nerve roots exit (lumbar stenosis). These steroid injections are costly and not without risk including a number of cases of infection in 2013-2014. A recent review of the available literature published in the Annals of Internal Medicine found limited effectiveness of these treatments compared to placebo trials f ..read more

Low back pain is a common problem and one of the most common areas we treat in our Boulder Physical Therapy practice. In Colorado, patients do not need a referral to seek Physical Therapy services and this pathway (direct access) has continuously been shown in the research to be safe, effective, and save patients health care dollars compared to seeing a physician first. This latter pathway is associated with higher costs secondary to unnecessary and costly imaging, specialist referrals, and procedures. In comparison, many large corporations and health care organizations are using Physical The ..read more

Is a picture worth 1000 words? When having low back pain, you may undergo an MRI or CT scan. As our technology continues to improve MRI and CT scanners have become more proficient at finding changes in our low back. This higher imaging quality comes with a cost in that many of these positive findings like “bulging discs”, arthritis, “pinched nerves”, “stenosis” and the frightening-sounding “degenerative disc disease” can be found in people without any low back pain. These MRI and CT scan findings can be found in up to 37% of people in their 20’s and up to 96% of people in their 80’s (Brinjikji ..read more

Strains and irritation to the low back can be very common but extremely frustrating when lasting longer than a few weeks. The low back (Lumbar Spine) is a large and resilient structure that can handle tremendous forces and movement; however the loads of activity can supersede the capacity of the low back tissue can handle. When this occurs, the irritation to the low back tissue can cause a cascade of events that must occur for the tissue and the low back to heal. The timeline of the healing occurs in 3 different phases called the “Phases of Healing”   Phases of Healing Phase 1: Inflammato ..read more

Did you know the more movies Nicolas Cage makes; the more people drown in pools? Or the worse the rating of M. Night Shyamalan on Rotten Tomatoes; the less total newspaper sales? There is a significant difference between correlation and causation in the world and is especially noted in medicine. As we all deal with low back pain, injury, or dysfunction, we naturally look at the preceding events to determine what might have led up to injury. This is human nature as we try to control the “why” or circumstances that creates the certain predicament we are dealing with. As a natural survival instin ..read more

Lumbar spinal stenosis (LSS) is a common diagnosis given to those experiencing low back pain. The gold standard of diagnosing stenosis is using an MRI to determine closure of natural occurring spaces of the lumbar spine. At times the closures can contribute to impingement of nerves or spinal canal which can lead low back pain and symptoms of numbness, tingling and weakness in the lower legs. Low back pain, specifically spinal stenosis and the management of the diagnosis has been studied thoroughly. A recent article by Kirker et al. 2022 in the journal of Physiotherapy Theory and practice exami ..read more

Low back pain remains one of the most common symptoms seen by both physicians and Physical Therapists. Physical Therapy remains the gold standard for the conservative treatment of low back pain due to its’ clinical effectiveness and cost savings vs. other forms of treatment including usual care. In our Boulder Physical Therapy practice we consistently follow the research and best practices for the treatment of this condition to ensure patients achieve optimal outcomes in fewer visits. Thankfully there is no shortage of evidence on low back pain to help guide our clinical practice. Recently th ..read more

Physical Therapists aim to utilize clinical objective tests to confirm their evolving hypotheses on the source of patient’s current symptoms. One of the most beneficial areas of our Physical Therapy and orthopedic research has involved the confirmation or refute of known clinical tests to identify patients with or without a given diagnosis such as an ACL tear or SI joint dysfunction. Unfortunately, some areas of practice are too engrained with clinician bias, financial incentive (continuing education courses) or lack of research knowledge to evolve with current best practice patterns. One of ..read more

Healthcare demonstrates significant swings of the pendulum in examination and treatment trends. Thankfully the medical evidence helps balance these swings allowing us to come to a more appropriate balance in clinical practice. Unfortunately, unchecked bias in a clinician, such as confirmation bias, can lead to missed diagnoses and inappropriate treatments. In Physical Therapy, this can be found among providers who search for clinical support of the diagnosis and treatment of SI dysfunction (sacroiliac) but refuse the clinical evidence which refutes those thoughts and beliefs. The selective bi ..read more