Jill Nader • 13 June 2024

Low Back Pain

Situation:
A 35-year-old male had a 15-year history of back pain. A former Division 1 college soccer player, he had a long history of “tweaking” his back and chronic low back pain. Recently, It had become so severe it was affecting his ability to do everyday activities. His previous treatments included brief stints of physical therapy but no long-term program. A recent MRI revealed two levels of disc herniation and early degeneration of the discs. At the time he was referred to me, he had stopped all physical activity due to increasing pain. Upon evaluation, he had no spinal mobility, severely decreased hip flexibility and was tentative in all his movements.

His goal was to perform everyday activities with decreased pain and learn a more intense, long-term back care exercise program for strengthening. He also wanted to return to working out for fitness and playing golf without hurting his back.


Action:
We began primarily hands-on techniques to decrease pain and get his spine in better alignment. Once he was out of the acute pain phase, we were able to start non-rigorous abdominal and low back strengthening as well as a thorough hip flexibility program. This took several months as we battled between episodes of acute pain during which he had to back off all his exercises and then resume when he was ready. Previously, he would not resume exercise for his back care after a pain episode for fear that it would cause further flare-ups or not help at all. This created a perfect storm for more pain and dysfunction. We were able to work through these episodes and continue to advance him during the “good” phases so that if he did have an acute flare-up he recovered more quickly and continued to improve his spinal mobility.


Results:

After weekly sessions over several months the patient now has an 85-90% improvement in his chronic pain. He has been able to return to activities such as skiing and golf without “throwing his back out.” He attends weekly Pilates sessions in which he is able to participate in an intermediate level workout without pain. He has a comprehensive advanced home program that he does on his own and then follows up with PT to advance when he is ready. He is experiencing a much better quality of life and is on the road to a long-term healthy spine.

Runner with Knee Pain

by Jill Nader • 13 June 2024
Situation : Patient is a 40 year old female runner with chronic knee pain diagnosed as “IT band friction” syndrome. For years, she would have pain on the outside of her knee during and after running. She underwent physical therapy which mainly treated her knee joint with modalities and quadriceps strengthening and IT band stretching. When she was referred to me, she had already undergone an arthroscopic surgery which revealed no internal problems with her knee. She was still having a lot of pain and significant swelling after the surgery. Action : The patient’s overall posture and pelvic alignment were evaluated and treated first. It was found that she had a rotation of the pelvis that was affecting her lower body mechanics. After treating that with manual therapy, a thorough analysis of her gait was performed. She was then given home exercises to strengthen muscles around her hips and spine to support her in a better body alignment. In the clinic we progressed with a Pilates-based rehab exercise program to improve lower body alignment and core stability and simulate her mechanics needed for running. Results : The patient recovered very well and was able to return to running without knee pain. She continues her post rehab work with regular Pilates classes for fitness and injury prevention.

NFL Player with Chronic Foot/Ankle Pain

by Jill Nader • 13 June 2024
Situation : A 28-year-old professional football player with a 10-year history of chronic ankle and knee pain presents with a three-month history of Achilles tendonitis. He has had no relief with conservative treatments in the training room, so the trainer referred him to me to evaluate and treat with physical therapy. Outside of this acute problem, he had constant daily pain that he just worked through and severe pain after his games for several days. Upon subjective history, it was revealed the patient had suffered a fracture of the first toe in college that was treated with only immobilization. He then suffered recurrent lateral ankle sprains and medial knee pain. His Achilles presented as extremely tender to touch and he had lost good dorsal glide of his talus so his ankle motion was very restricted. He also had severe over pronation of both feet and internally rotated hips. He also had several arthroscopic procedures to clean up the ankle joint over the years. Action : A series of joint mobilizations to the ankle joint to restore ankle motion were performed as well as myofascial release to the calf muscles to relieve tension off the Achilles tendon. We also addressed improving his hip strength and flexibility. He started a Pilates program to work on proper alignment of his foot and ankle as well as flexibility of his calf muscles. We progressed to more advanced work on the Pilates equipment to simulate actions he would perform for football. Results : The patient was able to recover and return to full football activities. He no longer had the chronic pain issues in his foot, ankle and knees. He maintained a regular Pilates program on his own and had a very successful season the next season. He was able to play a few years longer than anticipated because he was able to stay healthy.
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