“Dear Mark, I have a dilemma. I have a worn-out back, actrosis, edema, degeneration and 2 bulges l4-l5 and l5-S1. No nerve damage according to EMG and no entrapment according to MRI. Occasionally loss of feeling right toes, right leg and / or right buttock. They say it is radicular or something. Not treatable. Now I want to do some exercise myself despite the pain The pain clinic recommends Mensendieck / Cesar exercise therapy and stop everything else.
The physical therapist and manual therapist I go to in recommend medical fitness. The neurologist says that both are not scientifically substantiated. With exercise therapy I have to stick to the schedule they indicated, said the pain clinic and I am not allowed to garden. However, this is impossible since I have a 1300 m2 garden. So I tend to opt for medical fitness. But I’m unsure. Can you advise me?”
Excellent question and very understandable that there is some confusion when two different specialists give you advice which is directly opposite.
I think I can definitely get you started, let’s take a look at the points step by step.
In my opinion, the results of your MRI are promising. No nerve damage is the most determining factor. Things like degeneration and bulges sound scary, but nowadays we know that they are very common, even with people without complaints.
In the 40-50 age group, 68-80% of the population has this! And those are people without complaints, so they are not even aware of it! These factors therefore do not have to pose any restrictions at all.
I agree with your Physical Therapist in this area. Exercise programs that have been compiled with care generally have a tremendous influence on the complaints picture. It is important to find a therapist with a sports background who can look closely at the movements that are required during gardening. It would be even more ideal if he / she can drop by to see the garden and get an idea of how you are moving there.
Once this is clear, the necessary movements can be simplified to a level where the practice does not cause any complaints. From this point on, the program will be adapted to more and more resemble the activities during gardening. With good guidance, this should be all right.
During the build-up period I would recommend getting help for the garden. This can be a salaried person, but there are often also interns or volunteers who are happy to lend a hand. This way you can temporarily relinquish the difficult things yourself and for someone else this can be a very valuable learning period!
I hope this helps. If you cannot find anyone in the area, it is possible to request online guidance from us.
I am 65 years old and have a lot of complaints about my back .. osteoarthritis, scoliosis, increased lordosis, pelvic torsion ..
And a well-worn hip.
I have always been fitness until 2 years, but also got fibromyalgia .. too many complaints and I stopped ..
Do exercises at home with light weights and elastic and on the exercise bike.
I now have a spit and think it is advisable to start building up more muscle.
GP prescribes pain relief for nothing else ..
What do you recommend, low-level fitness or pilates for example?
Sorry for the long mail!
Answer (Mark Chen, Physiotherapist/Personal Trainer)
Thank you for your question. That is quite the list! Fortunately, none of the problems need prevent you from having a pain-free life.
I agree, strength training can help a lot.
It is important that a strength program is designed by someone who knows what they are doing.
Pain due to a scoliosis / lordosis often has to do with a imbalanced amount of stress on the muscles and joints as a result of the abnormal shape of the spine.
A properly chosen exercise program should be aimed at making the “underloaded” muscles work more, and the “overloaded” muscles less.
Pilates can be a good option for this because of the focus on tightening the right muscles. Nevertheless, I would go for a personal approach under the guidance of a physical therapist.
OCA is a company that focuses on an active approach to health complaints and they have locations all over the country. Take a look and hopefully they can help you on the right track!
A friend of mine, a very good golfer, has a lot of lower back pain (facet joints) as a result of playing and training a lot.
Manual therapy increases the symptoms. Is treatment on a traction table a possible solution?
Mark Chen, Physiotherapist:
Thank you for your question.
I personally do not consider a traction table as a ‘solution’. It can, however, provide a good relief of the discomfort and can therefore help as a way to start the recovery.
Traction works by relieving pressure on the facet joints. It ‘pulls’ the vertebrae ‘apart’ and gives space, so to say.
This can certainly provide some relief, once it has been determined that pressure, or ‘compression’, plays a significant role in causing the symptoms.
So it’s mainly a matter of trying. If there is no clear change in symptoms after 3-4 times, I would consider another method. It’s also worth noting, that it is fairly easy to create traction on the lower back yourself. For example, you can hang on a horizontal bar or use a Gym ball and lie down on it face down.
With both methods it is important that you fully relax the muscles.
Finally, I would advise him to have a good look at the mobility of the spine. Golf is, after all, a fairly one-sided sport that therefore loads the body (and especially the hips and spine) in an unbalanced way. With a view to the long duration, it is certainly advisable to follow an exercise program that keeps and maintains a muscular balance on the spinal system through flexibility and stability training.
I can help with that via online guidance, but there are of course plenty of Physiotherapists / Personal trainers who can help with that!
Hopefully this will help your friend!
Physio-Fitness is a way for you to work on your physical discomfort or injury under supervision of a professional .
After a personal consultation and assessment , the therapist will design and instruct a corrective exercise program for you.
During the Physio-Fitness classes, you will be able to exercise and get instant feed-back and answers to your questions.
This class is perfect for:
- Posture correction (anybody with an office job)
- (chronic) Low back/ hip / shoulder pain
- When you have tried any sort of therapy except training
- When you find it difficult to create the time to do your exercises at home
- If you want to get started with fitness, but have some weak points to work on
Currently, the class is on Monday 12- 1 PM.
- Please note the maximum attendance is 4 pax per class (currently 3 attendees)
- if you don’t require the full hour, coming in late or leaving early is fine
- Class is only available when you have a program designed for you
- Monthly Fee (1x pw basis) 60$
- Drop- in 20$
You can go here to make an appointment for a (free) Assessment
My name is Priscilla and I am 26 years old.
I recently discovered that I have hypermobility syndrome.
And my question was what are the best exercises to keep up with my body?
Because you are told and that’s it.
I don’t know how ,what ,where from now.
How can I best keep track of my body, what is best to do, how to prevent things, what resources are helpful to me in daily life?
I really hope you can answer me
Physiotherapist / Personal Trainer / Nutritionist
A very good question and coincidentally one that I recently encountered.
This lady had been complaining about hypermobility for more than 10 years, even while she had followed the advice she had received.
“Do not train too heavily, but focus on low-stressing exercises such as swimming and yoga”.
She particularly enjoyed Yoga, but it had no positive effects on her symptoms.
For me, that is a lot less surprising than for her for a very simple reason. Hypermobility means increased mobility of the muscles and joints. In those cases, flexibility is the problem!
Then why would you focus on Yoga, which is specifically designed to increase mobility?
I advised her to (completely) stop Yoga for the time being and fully focus on stability. As soon as she can support her own body in the right way, it is time to carefully start Yoga again.
She followed a strength/stability schedule for 12 weeks with a strong focus on gymnastics and is now completely free of pain for the first time in 10 years. So this is very possible with the right approach.
Of course, that is where the challenge lies, and you will have to find someone who can guide you through this. If there is nobody around you who can do that, then the new video guidance I offer might be something for you!”
“Since a month I have had pain in my lower back. Also occasionally in my right buttock and when sitting. I regularly use a heat patch on those spots and a broad back strap, which relieves the pain slightly so that I can keep moving. If I sit too long, walking is painful afterward. This is due to my age, I am 65 years old. I also regularly have sensations in my legs when I sit too long, after about two hours. After ten minutes of walking or standing for too long, my right leg hurts. Whether it’s the bone or the muscles, I don’t know. I think the muscles myself. I’ve had this for a few months.
Now I have a dead feeling in my toes of my right leg. In addition – for two weeks – also my heel and side of my foot. Since today also the side of my lower leg and thigh. Can this be the result of a pinched nerve in my back and does this go away on its own or is it necessary to consult the doctor?”
Mark Chen, physical therapist:
Of course, your complaints may be the result of nerve irritation, but in most cases, nerve problems are very obvious!
Nerves are responsible for very sharp, recognizable, almost “lightning-like” sensations. Other nerve-related pain, such as toothache, is characterized as a constant nagging pain that can be so strong that it is difficult to focus on anything else.
It may also be that the problem is muscle related. Sometimes problems in the muscles can cause radiating feelings to other places in the body.
By applying pressure to the designated areas in the muscles, the signals can sometimes be generated in the radiation area. You can try this with your fingers, but it is usually easier to use a tennis ball or another hard ball for this. If there is a clear link between the pressing of the muscle and the sensations in the known area, then there is a high chance that it is a muscle related problem. That is a good sign because muscle problems are generally a lot easier to solve than nerve problems.
If this were not the case, the most logical step would be to go to a therapist for a diagnostic examination. He/she can then give you a good idea of what is going on, and otherwise, you can be referred for a scan.
I hope this helps.
“I am 64 years old and heard a ‘crack’ in my knee when my upper body turned to the left. My knee stopped and locked. I’m worried that I may have torn my meniscus, or maybe my cruciate ligament. I read on the internet that surgery is not done beyond a certain age. Is this correct? Which exercises do you recommend to have my thigh muscles take over the function of the cruciate ligament?”
The diagnosis has not yet been made, this is based on my own assumption. I lead a quiet life without sport, but I do cycle.
What should I do with a torn meniscus? My outer meniscus was removed forty years ago.”
Sent by: Ineke
Mark Chen, Physiotherapist:
Whether or not the operation is done depends more on the general health and functioning of the knee rather than on age. In order to know this for sure, you could briefly consult with the GP or the orthopedic surgeon, or who would be the designated person to perform any procedure.
You indicate that the diagnosis has not yet been made. It seems like a good idea to at least have the knee examined by a specialist and have the cruciate ligament tested. If they turn out positive then there is a considerable chance that there is actually a tear. In the case of a “crack” or a hairline tear, an intervention is probably not necessary.
The cruciate ligaments are mainly needed for fast movements and when we change direction. Think for example of tennis or football. When cycling and walking cover the largest part of your exercise activities, there is a big chance that you can continue to function completely without problems, even without a cruciate ligament.
I recommend visiting the physiotherapist to at least have the knee examined. He/she can immediately give exercises to strengthen the knee if necessary.
I hope this helps!
Ps. we have a team of experts that can help out with almost any questions related to health and fitness. Have a question? Send it in!
I just got operated for a herniated disc between the 6th and 7th vertebra along the back of the neck. A part has been removed. I had a nerve failure in my left arm because the nerve was compressed by the herniation. Now I have one problem; I walked 2 or 3 times a week for 1 hour but according to the doctor that is not very good for my neck because I have osteoarthritis between my 5th and 6th cervical vertebrae (strongly narrowed intervertebral space with slight disc herniation) and the other cervical vertebrae have small disc protrusions)
My question now is whether it is wise to buy a cross trainer and to maintain my fitness level that way. I mainly did fat burning and endurance.
I am 50 years old and still want to be active and have no overweight bmi = 21
Mark Chen, Physiotherapist:
I think it is certainly a good idea to keep the condition up to date via a cross trainer. I would certainly also put the advice of the GP to the test.
The idea that osteoarthritis should be a reason to be careful is very old-fashioned. To get an idea of what I mean, take a look at the next image.
Recent scientific research has tested the causal relationship between abnormal findings and pain by allowing people to take an MRI scan without any symptoms.
These studies show that there are a huge percentage of deviations that in these cases are totally unpaired with pain.
For example, for a disc “bulging” as you describe, 87% !!!
For degenerative changes of the discus, such as dehydration/desiccation, as many as 96%!!! of the older population.
This group, again, does not experience any pain.
This should be a reassurance. The findings in your neck are normal, and not necessarily responsible for any pain.
Of course, from my position I can, not determine whether there is actually a connection!
My advice would be to find a sporty physiotherapist who can help with this process. The neck must be tested slowly to see what is and is not possible!
In this way you will probably be surprised at what is possible. The idea to reduce a basic activity such as walking at such a young age (provided there is a good reason) does not seem sensible to me.
I hope this helps!
“I suffer from a bursitis in my shoulder. Now I have heard that an injection does not always work. Can I benefit from physiotherapy?”
Mark Chen, Physiotherapist
How annoying that you have bursitis: They can, especially in the shoulder, be very persistent.
Injections are an often used treatment for bursitis and other inflammatory issues. The results are variable, but generally very good. With such an injection, corticosteroids are injected into the joint, with the intention of reaching the bursa, or whichever structure is the problem. A good placement of the injection is, therefore, very important.
The cortisone that is used is a variant of a hormone that the body itself makes to combat inflammation. When cortisone is administered from the outside, the immune system is suppressed and the body temporarily stops with production. In the short term, so with a single injection, that is generally not a problem. But the use of cortisone in the long term can have adverse effects, such as atrophy (decrease) of muscle tissue, decrease in bone quality and susceptibility to infections.
If you opt for treatment by a physiotherapist, you will probably look at the underlying cause. When the bursitis in your shoulder is not caused by a trauma, there is often a reason to find in the mechanics of the shoulder, posture or behavior. You can identify and solve these types of causes together with a therapist. In many cases, an injection is not required.
I myself always advise people to take a close look at the immune system. Are there ways, for example in your diet, to support the body in its own abilities to heal? When the shoulder is relieved, the body is well hydrated and provided with sufficient building materials, then you are often perfectly able to solve an inflammation by yourself.
Of course, one does not have to exclude the other. The physical therapist can inform you if and when it is wise to choose an injection.
Hope this helps!
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