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#1 Mistake We See People Make with Back Pain, Hip Pain, Knee Pain, etc. (Physical Therapist View)

This article is a transcribed edited summary of a video Bob and Brad recorded in August  of 2020.  For the original video go to: https://www.youtube.com/watch?v=UXxjAUvsFLs&t=470s

Bob: Today we’re going to talk about the #1 mistake we see people make with back pain, hip pain, knee pain, etc. This is a physical therapist viewpoint.


Brad: Boy, that’s covering quite a bit of anatomy with one show.


Bob: We don’t want to leave anybody out. So, the first mistake we see people do, if something hurts, what do they do?”


Brad: Protect it. It’s not necessarily a mistake.


Bob: Right, but if they continue to do it, it is. When you first hurt it, a lot of times, we want you to rest it. I just saw a study, Brad. They talk about the P.R.I.C.E. Method of protection. They thought, no it should be the M.I.C.E. Method. Movement right away. They talked about movement almost the first day.


Brad: It’s like after a knee replacement.


Bob: Right. Look at the trauma that the knee underwent.


Brad: That’s true, that’s a good point.


Bob: We’re not judging by the way. It’s completely understandable when you hurt an area, you don’t want to move it. It hurts to move it. The swelling increases and the blood flow decreases and tightness sets in. So, we’re going to just tell you ways to try to help get those areas moving, that maybe are going to be a little less painful.


Brad: That’s a big core of physical therapy treatment, is range of motion, get things moving. There’s some little tricks that you can make it move without pain and that’s our specialty.


Bob: We try to decrease the weight bearing on the area and we try to find the movement that works and you start off slow. Alright, let’s talk about back pain. I had a friend that worked in a back-pain clinic. I’ve told this story probably 100,000 times, but he worked in the back-pain clinic. All they saw was back patients. First thing they do, you get walking. You see a lot of people with back pain and they’re like, “It hurts,” so they just lie down, sit down, or they don’t move. Now you say, well, how do I decrease the weight on my back? Well, one, you avoid hills and stairs and stuff like that.


Brad: Flat surfaces.


Bob: Yes. But actually, if you increase your speed, that decreases the amount of weight on your spine.


Brad: Now, that’s not saying that you should go speed walking. But from a slow cautious pace to a smooth little bit faster, can make it feel better and let things work in.


Bob: You really want to have good posture when you’re walking. We tell people a lot of times to grab your wrist with the opposite hand and just pull back. That straightens you all up and sometimes we even have people walk like this with their hands behind their backs.


Brad: Now, if your back pain is so bad that you can’t straighten up, then you’re going to have to go to one of our other videos. There are other exercises in those.


Bob: Obviously there are people that can’t walk. I’ll tell you Brad, when I’ve had episodes of back pain, I’m running the next day. I’m back to running because it feels better with running, when I get to moving. Now the next one is we wanted to do a directional movement. The one that we find, the go-to movement, for people with back pain just to get things moving, is we bend the knees up, and call it the hook lying position. We just gently go back and forth. You’re just getting the little movement in the back, rotations, and if you find out one direction hurts, then just go to the opposite side and work it that way for a while.

Brad: Bob’s shoulder and trunk stay stationary, if you will. The pelvis and the knees kind of rotate together and that puts a little movement in the back.


Bob: Another one you could try, if you’re younger, I would say. Let’s say you’re less than 40 or maybe even 45. I would try press ups. You’re going to put your hands underneath your shoulders and you’re going to lift up. You’re not going to lift your pelvis up and you’re only going to go up to what is comfortable. We do what we call micro press-ups to start off with. When it starts to feel more comfortable, you can go further and further. Again, I’m keeping the pelvis down on the mat or the floor or the bed, where-ever you’re at.


Brad: There are a couple groups of people, usually they’re older, but if you have spondylolisthesis, that could be any age, or stenosis, you’re going to try this movement then.


Bob: A single knee to chest to start off with and then go to a double knee to chest. The next one is hip pain. We want to get the hip moving. Again, the movement we find out, is actually the same one we do for back pain. We have them lie down. I have people do this before they even get out of bed. I say, “you wake up in the morning and before you even get out of bed, put your legs in the hook lying position and move the hips.” Same thing holds true for them. If it hurts in one direction, don’t go that direction.


Brad: You could actually go into the clamshell which would work more the hip joint itself. Like butterflies, kind of thing.


Bob: Just getting some movement. What we find is that people after they’ve been sleeping all night, and that joint hasn’t been moving, it gets worse. That’s the thing you want to understand about arthritis. It actually can get worse at rest. The joint likes to be moving. We want to get that synovial fluid moving. We want to get the blood flow moving. Anytime you can get some movement, it’s going to generally be better. It can get to the point, I’ve seen it in shoulders, where arthritis got so bad, like it’s way advanced stages, that we don’t do any movement. It just hurts.


Brad: That’s the extreme cases. But it’s rare.


Bob: That’s usually when someone’s had it for a long time. Brad, do you want to show the FitGlide?


Brad: Oh absolutely.


Bob: Another way to get the hip and the knee, we might as well jump ahead, this one is also good for the knee.


Brad: Right, it’s good for both. It’s not uncommon to have both. If you have hip arthritis, you

may have some tightness in the knee.


Bob: You can also go biking. If you have like a stationary bike. We like the FitGlide because, well one, we invented it, LOL. Two, it’s really light weight. Did we determine how much this weighs?


Brad: This is under 5 lbs.


Bob: You can lift it with one finger.

Brad: The reason we invented it was because there was nothing out there that fit the ticket and we were always having a need for something like this in therapy. Something that would work both legs, something you could adjust the height on where you can have an incline or a flat floor. Something that would last forever and work well.


Bob: Another point, Brad, is a lot of times, people, when they have a stiff knee or hip, they can’t go a full circle. You know what I mean, they can only go halfway.on a stationary bicycle. But they all can go back and forth.


Brad: That’s a good point.


Bob: It’s a great way for starting. The only negative thing I’m going to say here, Brad, I know you don’t like it when I say this, but it is not quiet. It does make a swishing sound.


Brad: Yeah, but not very much.


Bob: No, but not very much.


Brad: If you use silicone, just a drop or two, it helps. I had a patient that used one in a quiet office and he just put a drop or two of silicone on it and it just quiets right out.


Bob: You can use it lying down too and it works better with shoes or sometimes we just take a towel and put it under your feet.


Brad: It’s a nice surface, it’s not going to cut you or anything. You can do this in bed, if you’re having a hard time getting out of bed, you need to exercise, prior.


Bob: That’s what I like about this thing. I can’t think of anything else where you can work out in bed like this and start moving that hip and knee before you even get up in the morning.

Brad: It’s very light. You can clean it very easily too. Everything about it is beautiful.


Bob: Again, you can try, if you had a stationary bike, you could try that if you already have one. We aren’t saying you need to go buy one by any means. Alright, after you’ve done everything for hip pain, we also wanted you’re walking with the hip pain, but you’re probably going to want to walk with a cane. What you want to do is walk with the cane on the opposite sideas your pain.


Brad: Okay, here’s my sore leg, my left one, I’m going to put the cane on the right side. A lot of people think you should have it on the same side, but it’s not true. When you advance your sore leg, the cane advances with it. Typically, what I do with a patient, I’ll say, “Put it in your right hand.” That’s the sore leg. I won’t give any instructions. Usually people naturally go to the same side.


Bob: If you want to screw them up, you start giving them instructions. So, the knee pain’s

going to be the same thing. You can also walk with the cane with the knee pain.


Brad: Knee or hip, yes.


Bob: So, get those joints moving. In most cases, it’s going to be the right thing to do, unless you have a fracture or something like that, some type of trauma. Obviously, then you need to see the doctor, but movement, movement, movement. Remember, Brad and I can fix just about anything,


Brad: Except for,


Bob: A broken heart.


Brad: That’s right, Bob.


Bob: You can count on us.

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