Physical therapist explains what to do, and not do, to protect your back

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Today we'll be talking about what to do or not to do in order to maintain a healthy spine with Ryan Martin, a doctor of physical therapy at Upstate. Welcome to "The Informed Patient," Dr. Martin.

[00:00:26] Ryan Martin, DPT: Thanks Amber. Thanks for having me.

[00:00:29] Host Amber Smith: From early childhood, I remember being told about the importance of good posture. Does posture in childhood impact the spine in adulthood?

[00:00:38] Ryan Martin, DPT: Yeah. Absolutely. Posture, I would say, is probably one of the most important things really when it comes to spine health. So, the earlier of an age that you're learning good postural habits and practicing that and that's kind of becoming your default position and postures then you're setting yourself up for success there. You're avoiding placing excessive and unnecessary stresses on the spine. So I would definitely say that's true, and starting from a young age, again, you're setting yourself up for success there.

[00:01:14] Host Amber Smith: what are the most common mistakes you see with posture with adults and children?

[00:01:19] Ryan Martin, DPT: It's usually pretty common to see that as we're sitting down, we often slouch to some degree, right? So as opposed to sitting upright a little bit more, we tend to slouch out in our chair. If you think of when you're standing and you place your hand on your lower back, you can feel that there's a little bit of a curvature there, right? A little bit of a lordosis as we call it. So when we sit down, often, again, we slouch. That lordosis, or that curvature, kind of decreases and flattens out, and that, again, puts you in a position where there's increased pressure on your spine from the lumbar spine, the low back, right up through your upper back and your neck. So I think most people can probably relate to that and have caught themselves slouching at times. So that's most commonly what we see typically.

[00:02:19] Host Amber Smith: Does poor posture give you back pain? I mean, how would you know that you have bad posture?

[00:02:24] Ryan Martin, DPT: Again, posture is one of the most important things for spine health, and it's definitely something for my patients when I'm working with patients in the clinic, coming in for spine issues, it's always one of the main topics and things that we're working on. Not just to maybe help get them out of that episode of pain, but also to help maintain a healthy spine after the fact, after they've recovered.

[00:02:53] Host Amber Smith: Does footwear contribute to posture?

[00:02:57] Ryan Martin, DPT: Yeah. So anytime we're standing, we're on our feet, everything kind of starts there at your feet, really, right?

So, if you're wearing maybe not the most supportive footwear, not really giving you great arch support, and that's allowing your arch to maybe collapse more than we'd like, that affects everything up the chain as far as your lower extremity. You know, your foot collapses into that position. It's going to affect the knee, which is going to affect the hip. So it all kind of starts there.

[00:03:31] Host Amber Smith: So, yeah, you want to make sure you're wearing some appropriate footwear with some decent support. So for people who have jobs where they're sitting at a desk all day, how do you feel about standing desks or, I know there's a variety of specialized chairs. Do those help with posture?

[00:03:52] Ryan Martin, DPT: I think the standing desks or the adjustable work desks, I think those are a great option, like you said, especially for people that have a more sedentary desk job. That prolonged sitting is probably one of the biggest stressors on the spine. I know people typically tend to think of maybe bending over, lifting, things like that, which does stress the spine, but that prolonged sitting, probably even moreso, like you said, especially for those folks that have a sedentary based job at desk work.

So those standing desks, they allow you to stand up change positions. It maybe wouldn't be the best thing, either, to be standing there all day, but it gives you that option to break things up throughout the day. So that's, again, something I'll often recommend to patients of mine if they're dealing with a spine issue and they have a desk job, that's something that I'll often recommend to them. There's varying versions of that from the whole desktop raising up and down to other ones that you can basically just kind of set your computer on and that'll raise up and down. So those are a great option.

As far as specific chairs, I don't usually recommend anything too specific there. Essentially, as long as, again, the chair is somewhat of a nice, firm back and upright back, where it's kind of promoting that upright posture, I think people are in good shape with something like that. A lumbar roll is something that can really be useful as well, like a lumbar cushion, a lumbar pillow. Again, that's something you would just place in that hollow of your lower back when you're sitting, and it helps to promote that maintaining that hollow of your lower back, sits you up straight.

When we're sitting, that's really where our posture begins, is at the base of our spine, at our lower back. If you're sitting, and you're maintaining that curve of your lower back, it really sets you up for success elsewhere up the spine into your upper back and your neck. If you're sitting up there, it puts your shoulders and your neck and your head kind of automatically in a good position, versus, again, if you're slouched out from your lower back, it kind of tips your shoulders and your upper back forward, tends to promote that forward head posture, all of those things that are putting increased stress on your discs in your spine.

So yeah, lumbar rolls. Again, with any standard chair you can use a lumbar roll. I recommend that, again, usually to patients in the vehicle, at work, anywhere they're sitting for any length of time. And it's a great thing even if you don't have back or neck or spine pain. It's a good thing to just make a habit out of just for, again, overall spine health through the lifetime.

[00:06:48] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with doctor of physical therapy, Ryan Martin, about how to maintain a healthy spine.

How often do you see people who injure their backs trying to lift heavy objects?

[00:07:04] Ryan Martin, DPT: I do see that. But like I was saying earlier, I think more than anything it's often more of these cumulative stresses on the back. I would say probably more often, again, just from poor postural habits and the cumulative stresses that come with that. Not that people, again, can't injure their back or their spine through a certain heavy force. I think sometimes when that does happen, it may just be the straw that breaks the camel's back kind of thing where they maybe had this issue, kind of brewing, and that was just the extra stress on the spine that really kind of tipped the scales there.

[00:07:48] Host Amber Smith: What advice do you have about the right way to lift?

[00:07:52] Ryan Martin, DPT: Probably the type of thing most people have heard as far as bend at the knees and the hips. Try to make most of the movement come from there, where you can rely more on your lower extremity, your leg muscles and avoid just all that bending and motion coming from your lower back.

That's another area, again, we try to educate patients on in the clinic is good body mechanics with bending and lifting. You can get most of the way down into a squat toward the floor and really still keeping your low back and your spine in a relatively neutral position if you're really squatting down from more of the hips and the knees. So, another way, again, to reduce those stresses on the spine. A good thing just to try to make a habit out of, to set yourself up for success and avoid developing spine issues.

[00:08:48] Host Amber Smith: How much of a role does a person's weight play in putting stress on the back?

[00:08:54] Ryan Martin, DPT: I would say it certainly plays a role to some extent. I mean, the more weight or mass that we're carrying, the more pressure and force that's being transmitted and loaded on the spine. So I would certainly say it plays a role.

Also, I think maybe sometimes it can be maybe something of a scapegoat. I've encountered a lot of patients where they may be experiencing some spine issue or another, and sometimes they're just kind of told, "well, you know, you're overweight. You need to lose some weight," and then that's maybe just the easiest thing sometimes to point a finger at.

So I would say it plays a role to some extent, again, in so far as the forces and stresses on your spine. The more weight you're carrying, it is increasing your stresses there. But yeah, I'm not always so quick to point my finger at that as the primary issue most often.

[00:09:54] Host Amber Smith: Are there particular exercises that are good for your back, even for people who don't have back pain but want to prevent it? Are there exercises you recommend or things that you say not to do?

[00:10:06] Ryan Martin, DPT: Yeah, that's a great question. Certainly general strengthening and stabilization of your core muscles, your hip muscles, that's always beneficial, again, whether you're dealing with the spine issue or you're just trying to be preventative. So that's definitely a beneficial thing, you know, the more core strength and stability you have.

And one of the big things we'll often explore in the clinic, if somebody's coming in for a spine issue, there's often what we call a directional preference, which just means that there's a direction you can move the spine or stretch the spine that will relieve pain and hopefully help actually resolve the problem. So depending on what the issue is and what is causing the pain. That could be bending forwards. It could be bending backwards. It could be lateral movements. But there's often a specific direction of movement for the spine that can help relieve pain, resolve these issues. That's something that you really would probably want to explore more with a physical therapist or somebody who's trained in that.

Those things are important. There are, again, stretches that can be done that help to offset a lot of the daily stresses and pressures on the spine as a whole. We tend to do more forward bending, right? As far as bending forward, picking things up, bending over towards the floor, putting our socks and shoes on. So we tend to move more in that direction in regards to the lower back. And it's less common that we move into more of a backward bending direction.

So oftentimes, that can be beneficial for helping decrease the incidence of some of those disc issues that we commonly see. So yeah, that would be some of the main things, again, we'd work on in physical therapy, identifying any directional preference, strengthening and stabilization exercises. Those would be the main things.

[00:12:22] Host Amber Smith: Is running a healthy activity for the spine?

[00:12:25] Ryan Martin, DPT: Yeah, I would definitely say really any form of activity and movement and exercise, you know, as long as it's done appropriately. I wouldn't want to see anybody try to take up running and start doing excessive mileage too quickly. That can cause injuries in and of itself. So you always want to build up to those activities and allow your body and your tissues time to adapt to those maybe new stresses you're putting on it. So as long as it's done in a smart way, and you're working your way up gradually, definitely. And again, activity, movement, exercise in general is some of best things for the spine.

Again, usually the problem is that we're spending too much time sedentary, sitting in one position where you get that cumulative stress on tissues and on the spine.

[00:13:29] Host Amber Smith: Well, let's talk about sleep. What is best for our spine: firm or soft mattress?

[00:13:35] Ryan Martin, DPT: It may come down to each individual in terms of their spine and what particular issues they may be dealing with, whether they may have stenosis or if they're dealing with a disc issue, as well as what positions they tend to sleep in. If they're more of a back sleeper, a side sleeper, stomach sleeper. So that one would be another one of those things where you probably would want to talk that through with a therapist or somebody along those lines to kind of individualize that based on, again, any diagnosed conditions in patient sleeping positions and preference there.

[00:14:17] Host Amber Smith: So sleeping on the back versus side or stomach, all three of those could potentially be OK for someone who's wanting to keep their spine healthy?

[00:14:27] Ryan Martin, DPT: For the most part, I think as far as when I'm working with patients, when it comes to sleep, they're going to, they kind of have their set positions where they're comfortable in and that they're able to sleep in. So, again, depending on what they may or may not have going on, I'll try to work with them to find ways of making that, again, less of a less problematic.

But as a whole, any of those positions should be fine. With a typical individual with with a healthy spine,one thing I'll often advise patients on, if they are more of a back sleeper and they're sleeping on a very, very soft surface or mattress, it can kind of promote them kind of sagging into that mattress a little bit and again, kind of having that effect of rounding out the lower back, which can increase those pressures on the discs in the spine. So that can sometimes be detrimental again, depending on the individual and what they have going on in their spine.

[00:15:29] Host Amber Smith: What about hammocks? Are those a good idea?

[00:15:33] Ryan Martin, DPT: That would kind of go along similar lines, and even moreso. Again, if you were sleeping on your back in a hammock, that's really going to kind of curl you up into that, almost banana type shape, right, where certainly that's going to put a lot more pressure on those discs of the spine. It's putting your spine into more of that forward flex position. So that I would probably advise against for most individuals.

[00:16:03] Host Amber Smith: Does the type of pillow matter?

[00:16:06] Ryan Martin, DPT: As far as that goes, I usually kind of gauge our patients more sleeping on their back or on their sides. You know, if you're sleeping on your side, then with gravity, your head is going to naturally kind of fall down toward the mattress that way.

So I usually tell people there if you're laying on your side, maybe to have a little bit thicker of a pillow or a couple pillows so that is helping to keep your neck in more of a neutral alignment as opposed to allowing it to bend to the side.

If you are more of a back sleeper, I usually advise people there that less is more as far as pillows go. If you're laying on your back, the more pillows you have under your head, it's going to kink your neck and your head again, kind of into that forward bending position, bringing your chin more toward your chest, which again, will put more pressure on those intervertebral discs. So that's usually how I advise people there.

If you're a stomach sleeper, you're going to have to kind of rotate the head somewhat, one direction or the other. So that's usually my advice as far as pillow use and sleeping positions.

[00:17:23] Host Amber Smith: Well, we've all heard about the dangers of smoking and the link to lung cancer, but what can smoking do to our spines?

Smoking obviously has detrimental effects. On our bones it can increase risk for fracture and osteoporosis. It can delay healing of fractures. By virtue of all of that, that's going to affect the spine. So, obviously not a recommended thing for spine health. Anything we need to keep in mind in terms of nutrition that's good for our skeletal system?

[00:17:59] Ryan Martin, DPT: Yeah, I think, going back to the diagnosis of osteoporosis or osteopenia, which is just an earlier stage of osteoporosis, making sure that you're getting enough calcium and vitamin D. Your doctor may order bone density scans to assess that bone density to see if there's any stage of osteopenia or osteoporosis going on. In those situations where there is diagnosed osteoporosis, that can weaken the bone, of course, and that can result in vertebral fractures or compression fractures.

So it is important to make sure you're getting enough calcium and vitamin D and you're doing what you can to try to prevent those diagnoses of osteopenia, osteoporosis.

[00:18:49] Host Amber Smith: Do you recommend chiropractic care for someone who has an achy back?

[00:18:56] Ryan Martin, DPT: I think chiropractic can definitely be a valuable treatment. I've encountered a lot of individuals who have had great success with chiropractic treatment. Chiropractic treatment tends to be different from physical therapy, just different schools of thought and different approaches.

I've seen a lot of individuals, a lot of patients that have really benefited from chiropractic care. I'll typically advise my patients, if they're coming in to see me for physical therapy, I'll usually recommend that while they're coming to see me for physical therapy that they not also do chiropractic, or at least not add that in if they haven't already been doing it, just so that they're not getting those two treatments at the same time, because that can sometimes muddy the water. If they suddenly become better or worse and they're getting PT and chiropractic, you know, you may then wonder, OK, what made you better? What made you worse? It can just add another variable there.

But otherwise, like I say, a lot of people find great relief with chiropractic treatment. So it's definitely a proven treatment approach for primarily, especially, spinal issues.

[00:20:12] Host Amber Smith: What about massage therapy? Are there health benefits for the spine for massage therapy?

[00:20:18] Ryan Martin, DPT: Yes. I think massage therapy can be, again, another effective treatment. That's, of course, addressing more the musculature, the soft tissue. So if somebody is having maybe something going on that's more involved in the spine itself, deeper in the spine, whether it's a disc issue or stenosis, things along those lines, the soft tissue work or massage work probably isn't necessarily going to get at the root of that problem. But if it's more of just a muscular issue, of course that's going to help work out some muscle tension and pain there. And oftentimes, even if it is a situation of, again, a more of an issue within the spine, of stenosis, or a disc issue, often associated with that you may have increased muscle tone, increased muscle tension and guarding. So some soft tissue work, some massage can be helpful for that too. So it can be a good adjunctive treatment for that as well.

[00:21:26] Host Amber Smith: So what does a physical therapist do to help someone who struggles with back or neck pain?

[00:21:33] Ryan Martin, DPT: Starting from the first visit, you would come in for the evaluation. We'll put you through some different tests and measures, to help figure out what's going on, essentially, right. What is the cause of the pain is one of the most important things to, before you can really help resolve the problem. You have to kind of help figure out what it is, right?

So putting you through a series of testing and movements to try to help determine what the cause of the problem is. Like we had discussed earlier, we're able to advise patients on the safe and effective progression of strengthening exercises, stabilization exercises, range of motion.

Another advantage, again, with physical therapy is assessing for that directional preference. Is there a certain direction or movement for the spine that's going to provide you relief? Oftentimes, probably one of the most common issues in the spine is a disc bulge or a disc protrusion -- goes by many names, right? -- a slipped disc. People call it by many names. But oftentimes in those situations, there's a particular direction that you can move the spine to help relocate that disc bulge back into place where it belongs. So, again, we're able to help guide patients through that and hopefully identify a direction of movement that's going to provide relief.

[00:23:05] Host Amber Smith: Do you see more men or women with back pain, or is it pretty equal?

I would say it's pretty equally distributed. What about in terms of age? Do you see young and old?

[00:23:19] Ryan Martin, DPT: Yeah, absolutely. It's pretty common for spine issues to develop at any point in the lifetime.

Oftentimes, I think I see in the younger population, maybe it's more postural related, probably more often, versus as we age you may develop more arthritis, more wear and tear of the spine, maybe more of those diagnoses of, like, spinal stenosis. You can certainly see individuals with spine issues across the lifespan.

[00:23:52] Host Amber Smith: You're listening to Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. My guest is Ryan Martin. He's a doctor of physical therapy, and we're talking about maintaining a healthy spine

It seems like a real common injury or complaint to have back pain, but does that mean that it's normal? I'm trying to get at, at what point, if you have back pain, should you seek medical attention, or will it get better on its own?

[00:24:22] Ryan Martin, DPT: Yeah, like you said, it's a very common thing at some point throughout the lifetime to experience some sort of back pain or neck pain, and that's often the question, what's a normal ache or pain, and when should I seek treatment?

So I think some of the big things that, symptom wise, that would stand out, that would warrant seeking some medical attention would be, if you're experiencing, like, radiating or what we would call radicular pain. So, if there's nerve compression occurring in the spine, if that's occurring in the neck, you could experience symptoms traveling into the shoulder and down the arm. It could be pain. It could be numbness or tingling, more of those nerve related symptoms. It could cause weakness of the arm.

And as far as the low back, all of those same symptoms would pertain to the leg, right? Commonly known as sciatica. Certainly if you're experiencing symptoms into your arm or your leg, again, of numbness, tingling, pain, that would be worth getting checked out, seeking some medical help.

If these symptoms of back or neck pain or arm or leg symptoms are occurring in the context of any other changes such as like bladder or bowel function, that can be a red flag for some more serious issues that you would definitely want to get checked out, any difficulty controlling bladder or bowel or increased urgency, anything like that.

If you have any other kind of general health symptoms associated with the new onset of these symptoms, kind of overall malaise or fatigue or, again, other even seemingly unrelated symptoms that are kind of occurring around the same time that would, you know, warrant seeking some medical attention.

But as a whole, it's very common, again, to experience some localized back pain or neck pain here or there. If it's something that resolves quickly on its own, and it's not recurring often, then I don't think necessarily that's anything to worry about. Oftentimes in the clinic, by the time maybe somebody gets in to see me, they may get to me for that first visit, that evaluation and say, "you know, a month ago I was having this severe pain, and you know, now I'm actually feeling a lot better. I really am not having too much pain or issue at this point, but can you teach me maybe some exercises, some things that I can do to kind of help break that cycle?" Because oftentimes these spine issues, they are recurring, and they'll show back up, over and over again.

So I think that's something too. If it's an issue that tends to keep popping back up and you continue to have issues with that, even if it tends to resolve on its own, usually as more and more episodes show up, things often get worse with each progressive episode. So sometimes it's a good idea, even if you're not in an acute episode, to say, "OK let me go get some treatment. You know, let me learn what I can do to break this cycle and prevent this from continuing to recur."

[00:27:45] Host Amber Smith: So for an acute episode where someone has some back pain that develops, before they get in to see a healthcare provider, do you recommend ice or heat?

[00:27:56] Ryan Martin, DPT: You can really go either way. If it's something going on deeper within the spine, probably neither of those modalities are really going to be penetrating your muscles and all your soft tissue to really have a significant effect on the spine itself.

That being said, most people tend to do better with heat. It's going to have more of an effect of decreasing the muscle tone, usually providing some pain relief.

Ice, on the other hand, that also will usually kind of numb things out, if you will, and decrease the pain levels. It tends to have more of an anti-inflammatory effect. But again, it's different from an ankle sprain where you can kind of put the ice right on the ankle, and it's really getting at that area. If the problem is deeper within the spine, again, that cold therapy is probably not really penetrating deep enough there to have much of an anti-inflammatory effect. So I usually advise my patients, whatever you find to be giving you better relief. Most people tend to respond better to heat.

[00:29:05] Host Amber Smith: Well, Dr. Martin, thank you so much for making time to tell us about healthy spines. Thank you.

[00:29:10] Ryan Martin, DPT: Absolutely. Thanks for having me on.

[00:29:13] Host Amber Smith: My guest has been doctor of physical therapy, Ryan Martin from Upstate Medical University. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.