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Post-Operation? Surgery? into Rehab yet Winnipeg? need yourPhysio asap…

Joints just say no. Muscles grow weak.

 

We all know the body’s ability to do the mind’s bidding often falters later in life. But the effects of age on function can be especially unforgiving when you’re hospitalized. Knee replacements, hip replacement, arthritis, rotator cuff, spinal fusions, laminectomies, osteotomies…all common surgical procedures happening in Winnipeg everyday.

 

Lying in a hospital bed day after day can quickly undermine one’s mobility. Even though most of the hospital data comes from the USA; our nurses, doctors, hospital staff are experiencing the same trends in healthcare as the Boomers come into their 60s.

 

Hospitals get it. Care plans are developed for patients that prescribe exercise when appropriate. Doctors put in orders for physical therapists to help patients walk and otherwise preserve their mobility.

 

Nurses and assistants often are expected to help patients move, even if it’s just from bed to chair for their dinner.

 

But that doesn’t mean it always happens. When hospital units become swamped with particularly sick patients, preserving mobility can easily slip down the priority list, hospital administrators say.

 

“There’s the ideal world, and then the practical world,” said Liz Ericson-Macke, a nurse, social worker and case-management supervisor with the Franklin County Senior Options Program.

 

“Sometimes just getting people up and walking them may not happen as much as we would like it to.”

 

Michele Weber acknowledges that. While working on her doctorate, the clinical nurse specialist at Ohio State University’s Wexner Medical Center evaluated how well nurses stuck to the mobility guideline for intensive- and critical-care patients.

 

It took persuading, but physicians bought into the guideline that took effect in 2009. They issued a blanket order giving registered nurses greater power to decide when exercise and physical therapy were appropriate during stays in the ICU, which average 5.5 days. A physician’s order is still required for physical therapy, however.

 

In late 2010 and early 2011, Weber examined the care provided to 207 patients — 41 percent of whom were older than 60 — to see whether the guideline was being followed.

 

“We were following protocol 30 to 40 percent of the time,” she said.

 

There were several barriers to improving compliance, including factors beyond the nurses’ control. Some patients refused to exercise. Many hospital rooms are small, with constrained layouts that didn’t lend themselves to the right kind of chair.

 

In some cases, nurses didn’t have the right supportive devices — walkers, canes, gait belts — close at hand. Some equipment didn’t have battery backup so that IVs could remain hooked up to patients when they were up and about.

 

And inadequate staffing levels sometimes hurt compliance.

 

Today, audits show compliance is better, typically between 50 and 60 percent, Weber said. The hospital added the mobility guideline to the orientation process for new critical-care nurses, provided better equipment and balanced staffing.

 

Mount Carmel Health System declined to share similar compliance data. A spokesman for OhioHealth said the hospital system doesn’t have such data.

 

Efforts to get patients moving might seem at odds with another hospital priority: fall prevention. But Weber said there were no adverse outcomes during the OSU research project.

 

The benefits of getting a patient moving early have become more widely recognized, said Dr. Larry Swanner, vice president of medical affairs at Mount Carmel West.

 

“In the past several years, we have increased our focus on physical therapy,” he said.

 

For patients who have had hips or knees replaced, early exercise leads to quicker recovery times. For surgical patients, walking encourages deep breaths and coughing, which reduces the risk of pneumonia.

 

Meanwhile, patients who have undergone abdominal surgery might find that walking stimulates the return of their intestinal function.

 

If a physician orders physical therapy in the morning, it should take place that same day, Swanner said. If it’s ordered late in the afternoon, it should happen the next morning.

 

OhioHealth has been assessing many protocols, including for mobility, through a process-improvement group focused on geriatrics, said Michele Stokes, director of senior health services at the Gerlach Center for Senior Health.

 

“We really have a lot of opportunity across the system to be aware and do more for our elderly patients,” she said.

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MPI says 20,000 motor vehicle accidents in December, is this you? Winnipeg? Whiplash?

In my opinion, our Winnipeg streets have never been so bad in my lifetime; streets like Portage, Main, Pembina, Henderson have become obstacle courses of ruts and ice.
Today, another 10,000 accidents reported by MPI in the last two weeks! Cmon Winnipeg, we are the resilient drivers of Canada, we’ve probably seen it all! Little more time and space and you too can avoid that next injury claim

I can offer you this advice to make your injury claim as ‘painless’ as possible; whether it be whiplash, other neck pain, spinal injury, low back pain, knee sprain, shoulder strain, etc.

Always obtain a ‘personal injury or health’ claim number as this is a basic part of your ‘personal injury protection plan’ given by Manitoba public insurance if you are involved in a motor vehicle accident. The pain of the accident may not be there initially, but hours or days later.

In Manitoba, you do not have to see your doctor first before obtaining treatment from a physiotherapist. The physio shall assess your injury and determine if additional testing, medication or xrays are required.

MPI will send you an individual package of information regarding the complete process to cover all costs of your personal injury. Physiotherapy fees are billed directly to MPI, such that there are no ‘out of pocket’ expenses.

Education will be a key component of your treatment program; risk management, ergonomics, exercises, that involve home and work environment should be considered.

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Shovelling in Winnipeg’s Extremes; know your Biomechanics, your limitations and your Physio

A great bulletin from the Heart and Stroke Foundation; Snow shovelling may be dangerous for some hearts

Snow shovelling may be dangerous for some hearts. Reports have linked snow shovelling in extreme cold weather to an increased risk of hospitalization or death due to heart attacks. The Heart and Stroke Foundation advises taking extra precautions when snow shovelling during extreme cold alerts, particularly for individuals with a pre-existing heart condition or who are at high risk of heart disease.

Research shows that physical activity helps protect against heart disease, stroke and many other health conditions. It is also an important part of cardiac rehabilitation programs and an important way for heart patients to keep their cardiovascular system strong and resilient.

Extreme weather conditions, such as very high temperatures and humidity in the summer, smog, and cold winter days, can make physical activity more strenuous. Both strenuous exercise and extreme weather independently increase blood pressure, push the heart rate up, and increase blood concentration of fibrinogen, a protein involved in blood clotting. All of these factors contribute to increased heart attack risk.

The Foundation recommends approaching physical activity in extreme weather with caution if you have been diagnosed with heart or blood vessel disease (including stroke, previous heart surgery, and uncontrolled high blood pressure) or if you are at increased risk of a cardiac event because of high cholesterol levels, an inactive lifestyle being overweight, or obese or other risk factors. Speak to your doctor about what is acceptable for your health.

The risks become even greater when vigorous exercise and extreme weather are combined, such as when shovelling snow in sub-zero weather conditions. Studies show that in most people who have died shovelling snow or carrying out some other form of vigorous physical activity in extreme weather conditions, the plaque inside their blood vessels ruptured and travelled to the heart causing a heart attack. The rupture may be caused by increases in blood pressure or changes in vascular tone associated with physical exertion. Plaque is a sticky, yellow substance made up of fatty substances such as cholesterol, calcium, and waste products from your cells.

Here are some tips from the Heart and Stroke Foundation.

Take the time to do a few minutes of warm-up activity like walking to increase your heart rate slowly and prepare you for the activity

Build in frequent breaks from extreme weather activities so your body doesn’t become too strained

Ask for help from family, friends or neighbours if you need to do an urgent task, such as clearing snow, in bad weather;

Wear appropriate clothing and keep water nearby to replace fluids lost through perspiration

Plan ahead. Watch your local weather forecast for smog, humidity, heat and extreme cold alerts and plan for enough time or get help with major tasks like snow shovelling, on those days.

Stop your activity if you experience sudden shortness of breath, discomfort in the chest, lightheadedness, nausea, dizziness, or severe headache and immediately seek medical attention

Snow shovelling in very cold weather has specific risks. Here are some additional tips to help you stay safe during this particular activity:

Don’t continue shovelling just to get the driveway cleared in a hurry. If you’re tired, quit;

Don’t shovel or do any other vigorous activity directly after eating a meal. Your body is working hard enough just to digest the meal; adding vigorous activity on top of that could put too much strain on your heart;

Don’t stoop to pick up the snow; bend at the knees to avoid back problems.

Find out if your community offers programs or assistance for snow shovelling or snow removal (particularly for older adults or those with existing heart conditions)

Play safe Winnipeg; your your biomechanics, your limits and your Physio…

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It’s heavy snow Winnipeg, learn about rotator cuff injuries, the winter cold and shovelling

It’s snowing this morning in Winnipeg; the first heavy blast of winter this season. Car accidents, falls and shovelling injuries are inevitable. Beware of your posture, the load, your balance and fitness level before you ‘shovel for hours’. The shoulder, and its supporting rotator cuff group of muscles are highly susceptible to those strains n sprains of high repetition and little prep.

Rotator cuff injuries are common in all sports and can be career enders for athletes likes quarterbacks and pitchers. But even if you’re just throwing snowballs with the kids or working out to stay fit, it’s important to keep the shoulder joint healthy. Here, physiotherapist Chris Bisignano, answers some of the important questions.

Q1: What exactly is the rotator cuff?

“The rotator cuff is a group of muscles, that act almost like a dynamic ligament. It is comprised of four muscles: the supraspinatus, which is the most commonly injured, the infraspinatus, the teres minor, and the subscapularis. The rotator cuff’s functions are to assist with arm movements and provide stability to the glenohumeral [shoulder] joint.”

Q2: Why does the rotator cuff get hurt so often, and what are the common issues?

Most of the exercises we do actually do not specifically target the RC enough to make a difference to its actual strength.

“Up to 67% of the population will have a shoulder problem at some point in their lifetime, and the rotator cuff is most often the source of the pain. The primary reason for rotator cuff pain is that pinching sensation or ‘impingement syndrome,’ which may be the result of rotator cuff tendon inflammation caused by an activity or trauma. Over time, this can lead to a rotator cuff tear. To make matters worse, evidence suggests that most individuals are likely to experience rotator cuff degeneration by age 40 and rotator cuff tearing by age 60. Thus, in many cases, a seemingly normal exercise session or home-repair project may incite shoulder pain.”

Q3: What kinds of moves should I avoid if I want to stay injury free?

Repetitive reaches with even a simple load can isolate alot of force upon the RC. Movements above shoulder become risky when a joint is not supported well, or even unstable because of weakness.

“Many of the more common gym exercises—such as upright rows and lateral deltoid raises—may lead to rotator cuff injuries. Modifying these exercises to keep the end position of the arms or elbows below shoulder height may help prevent injury.”

Q4: How can I tell if I have a rotator cuff injury?

“Many people already have a rotator cuff injury and aren’t aware of it. Unfortunately, evidence suggests that these individuals will eventually develop symptoms. Early on, if you have pain when reaching overhead—pain located at the tip of the shoulder or the outside of the arm, where the lateral deltoid is located—that suggests a rotator cuff injury. Weakness when reaching the arm out to the side is also suggestive of a tear.”

Q5: How can I prevent a rotator cuff injury?

“Three key measures can be taken to reduce the chances of experiencing a rotator cuff injury.

“First, strengthen the external rotators; specifically by tubing or dumbbell exercises that need to be learned from a professional; these will help restore and maintain shoulder stability and may prevent impingement.

“Second, avoid sleeping on your side with your arm positioned overhead.

“Finally, try to achieve muscle balance—that’s key. Many weight-training routines are inherently biased, creating muscle imbalances that may lead to a rotator cuff injury. Try to perform an equal number of ‘pull’ versus ‘push’ exercises. Moreover, try to replace a few sets of shoulder exercises—such as lateral deltoid raises or shoulder presses—with exercises that strengthen both the deltoids and the rotator cuff, such as prone ‘Y’ or ‘T’ exercises.”

Visit yourPhysio or ask your healthcare provider for specific RC education and exercises.

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Posture, Form, Biomechanics…all important in Exercise Winnipeg to avoid injury

Winter is knocking at the door Winnipeg, back to your gym routine. You must practice the correct posture, form and biomechanics to avoid injury and the right choice in exercise. As a orthopedic physiotherapist, it is crucial to learn the biomechanics of an exercise first; otherwise injuries are eminent. Ask your trainer, yourPhysio or the gym supervisor for education as to how to perform exercise correctly, and gain the greatest benefit.

Ever tweaked a muscle when working out? Whether due to a loss of focus or chronic poor form, getting hurt when exercising can be a huge setback. Fortunately, weight lifting and cardio needn’t be dangerous if you can keep a few concepts in mind. For this blog post, you’ll learn how to stay safe with some of the more common resistance exercises, with good posture and technique.

Try this posture test: When viewed from the side, an imaginary vertical line should pass through your earlobe, the tip of your shoulder, midway through your trunk, over the bony part of your thigh, and then through both your knee and ankle. If there is any deviation from this alignment, like if your ears are in front of your shoulders or your shoulders roll toward your chest, you are set-up for potential injury.

Aside from maintaining ideal posture, try these technique modifications to avoid injuring yourself during 5 common exercises:
1. Squat:

Don’t let you knees drop inward. This common mistake can be remedied if you actively spread your knees apart. Try to keep your back straight as possible, body weight over your heels such that your center of gravity does not fall forward, potentially injury for knees and hips.

Our advice: Doing air squats with a mini band around your thighs is a good way to train proper technique.

2. Deadlift:

Avoid low back injury by maintaining your natural lumbar curvature.

Our advice: Imagine a broomstick running along the length of your spine; if your pelvis curls off the bottom of the stick during the deadlift, then you’ve lost your lumbar curve.

3. Shoulder Press:

Decrease the risk of shoulder impingement by mimicking the natural plane of shoulder motion.

Our advice: Hold your elbows slightly forward of your chest, rather than directly at your sides.

4. Plank:

Spare yourself unnecessary spinal compression by preventing your head and belly from sagging to the floor. Maintain thoughtful and regular ‘belly breathing’ to elicit a better core effort.

Our advice: Tighten your core and shoulder girdle so that you are one straight line from the top of your skull to your ankles.

5. Running:

Land as softly as possible to decrease impact on your joints.

Our advice: One method to do this is by decreasing your stride length, while simultaneously increasing your cadence.

Remember, none of these exercises should be attempted without proper individual instruction; there is no ‘recipe’ that works for everyone, consult yourPhysio or your nearest sportsmed doctor.

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Even science can provide ‘stats’ on sitting in Winnipeg to prevent neck and back pain, especially those Downtown, Physiotherapy Winnipeg can educate you

No one will stand all day when they have the opportunity to sit. This is because the body works harder when standing than when sitting. However, when we at yourPhysio.com in Winnipeg review work production studies indicate that workers are more efficient when they stand to work. So how do you decide between the two? Consider these general guidelines Winnipeg!

When Standing is preferred:

the task cannot be performed with arms kept comfortably by your sides.

assembling, testing, or repairing larger products (i.e., greater than 6 inches high)

the work area is too large to be comfortably reached when seated. Stand when you must reach more than 15” past the front edge of the workstation. The maximum reach envelope when standing is significantly larger than the corresponding reach envelope when sitting for both men and women (Sengupta & Das, 2000).

you work in more than one workspace to perform job duties and must move around frequently.
the work task lasts less than 5 minutes.

dealing with heavy objects weighting more than 10 pounds. In general, more strength can be exerted while standing (Mital & Faard, 1990) Stand when you need to maximize grip forces (Catovic, Catovic, Kraljevic & Muftic, 1991) or complete static or dynamic lifts (Yates, & Karwowksi, 1992).the work surface does not allow the worker to comfortably position legs under the surface because of an obstruction (i.e. working on a conveyor or a progressive assembly line, working in a kitchen, using a workstation with a drawer located underneath the work surface or a wide front beam, working at a retail counter, or using specialized equipment)

tasks require frequent application of downward pressures (loading bags, inserting screws)

Jobs that are most appropriately done standing include construction workers, highway flaggers, medical personnel, painters, electricians, plumbers, loggers, firefighters, plant inspectors, and maintenance personnel.

When Sitting is preferred:

Better when visually intensive or precise work is required, the activity is of a repetitive nature; longer tasks are completed (greater than 5 minutes), and when everything can be placed within easy reach. Sitting is not appropriate when heavy objects must be handled or long reaches are required.

However, prolonged sitting has been associated with a high incidence of back complaints (Mandal, 1981), increased spinal muscular activity and intradiscal pressure (Grandjean and Hunting, 1977; Lindh, 1989). Other problems reported include discomfort in the lower extremities (Westgaard and Winkel, 1996) and increased muscle loading of the neck and shoulder muscles when sitting with the forearms unsupported as compared to standing with the forearms unsupported (Aaras et al., 1997; Lannersten and Harms-Ringdahl, 1990).

To summarize the literature, neither static standing nor sitting is recommended. Take note of ‘static’ versus ‘dynamic’ Winnipeg, learn to balance each through your day.

Each position has its advantages and disadvantages. Research indicates that constrained sitting or constrained standing are risk factors and that alternating work postures may be preferable. Alternation between two postures allows for increased rest intervals of specific body parts, and reduced potential for risk factors commonly associated with MSD development.

Ideally, provide workers with a workstation and job tasks that allow frequent changes of working posture, including sitting, standing, and walking. If either sitting or standing is feasible but only one possible, sitting in a properly designed chair is preferable.

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Whether you sit at a computer, shovel snow, lift sandbags or play hockey in Winnipeg, your back pain is probably the result of tight hip flexors

yourPhysio anatomy lesson first; your hip flexors are the dominant muscle in the ‘knee to chest’ action. Anatomically known as your; Iliacus, Psoas Major and Minor, and your Quadratus Lumborum, these muscles are attached to your hip, to your lower back and your pelvis. Consequently, when overused or tight they can reconfigure your lumbar spine, throw out your hip and back, affect your sacro-iliac joint, and change your biomechanics thoroughly.

Even though stretching is essential for all muscle work, it can actually be damaging if not done properly. When you stretch without warming up your muscles, it increases your likelihood of injury, as you are trying to stretch a cold muscle. So before you stretch, make sure you warm up; walk in place, cross-train, and increase the blood flow into your muscles so you can prevent an injury. As a physiotherapist, I do commonly advise patients to hold a stretch for 20-30 seconds, but why? The reason is because our muscles have a protective reflex to avoid over extension or contraction. When you are stretching your muscle, the muscle spindles, which are the components that produce contraction, activate a reflexive pathway which causes them to shorten in order to compensate for the stretch (called the myotatic reflex). This is what causes your leg to kick out when you tap your knee.

Knee Reflex

There are two main types of stretching: dynamic and static. Static stretching is what we just talked about, which is a stretching routine that includes holding 30 second stretches for specific muscles. When using static stretching before a sport that requires you to use specific muscles to initiate specific movements, it is hard to relate static stretches to dynamic activity. This is where dynamic stretching comes in. Dynamic stretching is designed to mimic the actions and movements you are expected to perform during a specific sport. For example, this would include kicking around a soccer ball in warm-up before a soccer game, so your body can get accustomed to activating the required muscles. That way, your muscles can make the necessary preparations to prevent injury, as playing a sport requires many specific dynamic and explosive movements.

Starting blocks

For your hip flexors, I teach a ‘dynamic lunge’; such that your hip flexors, quadriceps and pelvic muscles are used within the stretch. If you add Kegel exercises to this movement, the pelvic floor muscles are activated more and a greater effort can be applied to this core stretch. Remember those pre-natal classes guys? A patient was recently surprised to know that guys can do Kegels too! Guys are equipped with those same pelvic floor muscles and ladies should appreciate these efforts, as do the men!
Overall, stretching is very beneficial for movements involved in a regular day, and those involved in heavy labor, repetitive activity and sports. Therefore, it should be a priority for everyone to incorporate some sort of stretching into their daily routine (after warming up of course!), in order to maintain optimal functionality.  Flexibility is a highly underappreciated component of muscular strength and function, but key to good performance at work, home and recreation.

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Core training not just for your abs, improve your sitting posture, prevent back pain by Physiotherapy Winnipeg

We’ve all heard physios, chiros, docs and fitness experts claim that core training is important for overall fitness and health. Health clubs offer core training exercise groups and physiotherapists recommend it for those recovering from spinal injury. Your core is the collection of muscles that stabilize the spine, this includes the hips, pelvis, abdominals, lower back, mid-back, and neck regions of the body. These muscles are extremely important in all sports, so why do so many ‘office athletes’ that basically sit for a living overlook core training?

The reason most people skimp on this vital part of their workout is because the benefits are simply overlooked.

Benefits of core training:

It’s important to note that performing a few crunches is not proper core training. As a matter of fact, I recommend that these be avoided for much of a lower back stabilization program. We simply just do not need any more ‘flexion’ in our daily routine; you sit most of your day!

Since your core involves many different muscles groups, a variety of exercises are needed to ensure you work them all; some exercises to explore include, but are not limited to, lunges, bridges, planks, and crunches. Every patient learns how to properly stretch their hip flexors, the ‘culprit’ muscle that usually guards when the ligaments are sprained in the lower back.

Pilates and Yoga classes are also excellent for strengthening your core muscles while also improving balance and posture. Check out Pilates Manitoba as they are offering 50% off their introductory classes for first-time participants.
When your core is strong, your whole body works better. Core training isn’t just for athletes, it’s for anyone who would like to have their body working at its greatest potential. For anyone just starting an exercise program, be sure to talk to yourPhysio first.

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Winnipeg, have you heard? Sitting is bad for you…solutions by Physiotherapy Winnipeg, yourPhysio.com

Winnipeg, by now you know you probably know that sitting down all day is terrible for you. As computer hardware and software accelerate the ‘web 3.0’, we can do more than ever before from a sitting position. Ergonomics is no longer a foreign word, and our ‘core’ exercises need to be performed everyday!

Who needs scientists to tell you that sitting for even one hour causes the production of fat-burning enzymes to decline a whopping 90%, or that more than four hours of desk time each day raises your risk of a heart attack by more than 100%?

You can feel exactly how crappy sitting all day makes you feel at the end of each workday; though you may be shocked to learn that being a regular gym-goer doesn’t protect you from the harmful effects of all that sitting. Standing up more is scientifically proven to have huge health benefits, but in our digital world it’s not as simple as it sounds. Here’s how to make the switch to an upright workday.

Try the latest DIY option, I have had so many patients describe their attempts at raising their work surface by box, crate, home-made devices, etc. I’m sure you could find the latest ‘how-to-video’ on YouTube to get an idea as to how to produce something for your workstation. Ergonomic clients of yourPhysio.com have purchased electronic and hydraulic ‘sit-stand’ workstations to allow their employees the postural variety that may be necessary for back pain, hip strains or knee sprains. These rehabs require movement throughout the day, and consistent changes in posture is a great place to start.

Invest in an ‘anti-fatigue’ mat, change your shoes every 6-8 months or try an over-the-counter orthotic to replace those worn insoles. You may require a doctor’s note to have orthotics covered by your insurance plan, but it is an employment benefit; so benefit!

Tweak your ergonomics, hire an ergonomic consultant for an hour and learn the proper way, not only how to sit, but how to perform your job so that it will not cause pain. Ask questions about posture, exercise and equipment available to make any task easier and less painful.

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Steroid injections for back pain can lead to bone loss, beware those with elbow pain, chronic pain, use Physiotherapy Winnipeg

Lately, many patients with chronic pain, including those with back pain, shoulder rotator cuff pain, elbow tendinitis pain or other chronic pain, have been asked by their family doctors ‘if they would prefer corticosteroid injections to physiotherapy?’

A Henry Ford Hospital, in Washington, D.C., study ( http://t.co/W3gj4dJt ) has found that postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief.

Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn’t receive steroid injection, researchers said.

Shlomo Mandel, M.D., an orthopedic physician and the study’s lead author, said physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.

“The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility,” Dr. Mandel said.

“Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient’s treatment plan,” he added.

Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.

There has always been the link, and the questions concerning steroid injection and tendon or bone deterioration. One of the more famous cases was that of Joe Montana, Hall of Fame NFL quarterback and his elbow tendon rupture following multiple injections. Now there are not many of us that perform at this level, but chronic pain of any type can be debilitating and life altering. Please know your options and be aware of all the side effects associated with longterm medications; the list of side effects may outweigh any medical advantage.

If you are considering steroid injection as a form of treatment; ask your doctor about his/her experience in delivering such a treatment option. An orthopedic surgeon or experienced sportsmedicine doctor would be a wise choice.

Your Physiotherapist should be able to address your concerns about such a treatment option, and he/she should be able to provide treatment relevant to your pain trigger points and the appropriate exercise to assist in your longterm rehab.