- Your Bridge to Health -

Best methods for improving sport performance and preventing injuries.
August 11, 2020

On all levels of sports, consistent and varied efforts are made to reduce the incidence of injuries. Warm–ups and group stretching routines are commonplace on most sports teams, while some organizations taking it a step further by implementing targeted injury–prevention programs specific to that sport. But which of these methods truly have an impact on injury avoidance and which may not be worth the time? And what role does specializing in a single sport play in an athlete’s injury risk profile?

Below, we aim to answer these and other questions related to the prevention of sports injuries.

Does stretching reduce the risk for injuries?

Stretching is easily the most popular pre–activity ritual of all athletes across the sports spectrum. This is why it may come as a shock to hear that in the majority of cases, stretching does not have the effect that most believe it has.

There are two types of stretching: static and dynamic. Static stretching is what most comes to mind when most people think about stretching. It involves the lengthening of a muscle until a stretch is felt or discomfort is reached, and then holding it for a period of time (usually 10–30 seconds). Dynamic stretching, on the other hand, involves actively performing a set of movements that resemble those involved in the sport to prepare the body for the demands of the activity that is about to come.

According to one systematic review, which analyzed the findings of 12 studies on these types of stretching, both static and dynamic stretching were found to improve athletic performance, but the effects were only small to moderate. In addition, static stretching had no detectable impact on the risk for injuries, while no data was available for dynamic stretching.

Other research has also suggested that dynamic stretches before a practice or game can improve athletic performance and possibly even lower injury risk, while static stretching has been found to potentially impair athletic performance. Thus, it’s recommended stretching should be considered optional before exercise and be based on personal preference. If you do decide to stretch at this time, avoid static stretches and instead complete a warm–up for at least 10 minutes that involves light aerobic activity and some dynamic stretching.

What about injury–prevention programs?

Another strategy to reduce injury risk is a more focused effort through carefully designed injury prevention programs. These types of programs are based around a single injury or group of injuries that are most common in a particular sport and aim to address any strength or mobility limitations that will make them more likely to occur. The goal is to train the athlete’s body to be fully equipped and prepared for the demands of the particular sport, thereby reducing injury risk.

One study that reviewed eight high–powered studies called meta–analyses on prevention programs for anterior cruciate ligament (ACL) tears, which are one of the most common and devastating injuries in sports. Six of these meta–analyses only included data on female athletes. Results showed that the prevention program led to a 50% reduction in the risk for all ACL injuries in all athletes and a 67% reduction for non–contact ACL injuries in females. While additional research is needed on male athletes, these findings strongly suggest ACL injury–prevention programs may be beneficial in sports that involve lots of high–impact landing and twisting movements. A program similar to those used in these studies can potentially be implemented during team warm–ups.

Does strength training have a similar effect on injury risk?

Strength training is also popular not only for improving overall fitness, but as a means to prevent injury. The concept is that stronger muscles will allow an athlete to better manage the “load” of their sport, which is how aggressively their tissues are challenged during performance.

To evaluate the effectiveness of strength training on injury prevention, a systematic review and meta–analysis was performed on six studies called randomized–controlled trials. Although the interventions used and populations studied differed between these trials, all six showed that strength training consistently reduced the risk for both acute and overuse injuries. In addition, a relationship was identified in which more frequent performance of these programs was associated with an even greater their injury risk. The quality of this evidence was also primarily rated as high and no negative side effects were detected. Therefore, strength training could serve as another effective intervention to mitigate injury risk in athletes.

What risk does specializing in one sport pose for young athletes?

About 72% of school–age children—nearly 29 million—participate in at least one organized sport, and this involvement is associated with a variety of physical and mental benefits. Many of these young athletes only participate in one sport and are often involved in practices, competitions, camps, and other forms of training throughout the entire year. This is called single–sport specialization, which is believed to help them eventually become elite athletes in the long term; however, it may not be the best approach for their overall development.

Research is plentiful on this topic, and according to one study, sport specialization is associated with overuse injuries, burnout, and social isolation. It can also lead to reduced motor skill development and may cause athletes to quit sports at a young age. For these reasons, young athletes should be encouraged to participate in a variety of sports during their early years so that they can develop a variety of motor skills and also identify the sports that they most enjoy. For those that do decide to specialize in one sport, participation (in hours) should not exceed their age, and those that engage in more than 16 hours of intense training per week should be monitored for signs of burnout and overtraining, which can lead to injury.

What role does sleep play in injury risk?

Adequate sleep is a crucial component of optimal overall health for all individuals, but it is particularly important for athletes. Fatigue is a major risk factor for injuries, and sleep deprivation contributes significantly to chronic pain. Good sleep habits, on the other hand, can boost athletic performance and will likely reduce injury rates.

According to one study performed on endurance sports athletes, getting less than seven hours of sleep over two weeks was associated with a significant increase in the risk for new injuries, while getting more than seven hours was linked to a significant decrease in injury risk. Hitting this mark is difficult for many athletes with busy schedules, but practicing good sleep habits is a key to exercise performance that should not be overlooked.

In our next newsletter, we’ll look at the role of nutrition in post–workout recovery.

Sports periodization can help you peak and avoid overuse injuries
August 4, 2020

As unfortunate as it is true, injuries and sports go hand in hand. An average of 8.6 million injuries in sports and recreational activities occur each year, which equates to about 34 injuries for every 1,000 individuals that participate. While some minor injuries might only lead to a short gap in participation, others can end seasons and lead to long-term complications if not rehabilitated properly.

Naturally, this causes most athletes to focus their energies not only on excelling in their respective sport, but also on keeping their risk for injury as low as possible.

One of the best ways to accomplish both of these goals is through an approach called sports periodization. The process of periodization involves planning one’s athletic training using a cyclical format that divides the year into specific blocks, with each block having a particular goal and every aspect of training being based on when the athlete needs to be at their optimal performance level. By designating when training intensity should be increased and when recovery is needed, an athlete can effectively increase their physical fitness while reducing their risk for overtraining and overuse injuries.

Macrocycles, mesocycles, and microcycles

In sports periodization, training blocks are referred to as cycles and training is divided into three primary types of cycles: macrocycles, mesocycles, and microcycles. Organizing and planning these cycles is an extremely individual process that should be based on when peak competition takes place in each calendar year, as well as the athlete’s maximum potential, their previous performances, and goals for the year. This means starting with a firm macrocycle in place and then refining it with smaller meso- and microcycles to guide training for month, week, and day.


  • A macrocycle is usually one calendar year, which should be oriented around the period of time an athlete needs to achieve peak performance (ie, the season or span when most competitions will take place) and build to that point
  • It includes several phases and incorporates long-term planning designed to ensure the athlete will reach their maximum potential at the right time
  • Phase 1: Preparation
    • This phase—which can last a month or more—is designed to help a rested athlete slowly return to training in a slow, controlled manner
    • Aim for easy, moderate sessions that are comfortable and steady
    • Walking, cycling, hiking, and swimming are all great options during this phase
  • Phase 2: Fitness base
    • Usually lasts several months
    • Focuses on improving all major areas of fitness, particularly building strength, power, and endurance
    • Should be more general for the entire body and address any weaknesses
  • Phase 3: Sport-specific fitness
    • Lasts about two months
    • Training becomes much more specific during this phase, with a focus on the skills and techniques needed in the respective sport
  • Phase 4: Tapering
    • Tapering means decreasing one’s training volume before major athletic competitions
    • This phase is only necessary for athletes involved in endurance sports like running, biking, and triathlons, when tapering should be performed before big races
  • Phase 5: Peaking
    • By this phase, athletes should be at their maximum performance level and ready to compete
  • Phase 6: Rest and recovery
    • A certain amount of time will always be needed to rest and recover after a big race or event


  • These cycles typically last for about 3-6 weeks and should have a specifically targeted outcome, which is often related to a component of fitness like power, strength, or endurance
  • Each mesocycle is further broken down into microcycles


  • A microcycle is the shortest training cycle and usually spans one week of training
  • These cycles are most specific and guide one’s daily training routines
  • Each week should include a combination of light and heavy days, as well as one day for rest or significantly reduced activity

In our next newsletter, we’ll review some other methods that can help reduce your injury risk.

Physical therapy provides the best option for most hip pain problems
July 30, 2020

After hip pain develops, movement can become a taxing affair. Standing up from a chair, getting into a car, and walking even short distances may be met with intense strain and discomfort. As a result, some individuals will become less active so as to avoid the pain that comes with it, even though inactivity can lead to worse outcomes in the long run.

In addition to avoiding movements that could potentially be painful, some patients will turn to at–home remedies like ice and heat, pain medications, gentle stretching, or self–massage. All of these interventions may serve a purpose and alleviate pain to some degree, but for pain that persists for several weeks after taking these initial steps, a more systematic approach will be needed.

Physical therapy is one of the many options available to address hip pain, but it is unique in that it teaches patients to overcome their limitations on their own by moving better and more efficiently. Physical therapy can also be performed effectively for patients of all ages and for the majority of conditions associated with hip pain, regardless of the level of severity. For patients with advanced hip osteoarthritis, it represents an alternative to surgery as well, which can lead to significantly lower health costs while producing similar outcomes.

A typical physical therapy treatment program for hip pain

After conducting an initial evaluation, a physical therapist will design a personalized treatment program tailored to patient’s abilities, goals, and preferences. These programs will differ depending on the condition(s) present, but common elements found in most include the following:

  • Strengthening exercises that focus on the muscles of the hip, as well as the core and legs, which will also affect hip function
  • Stretching exercises to increase the flexibility and range of motion of the hip joint
  • Manual therapy, in which the physical therapist will gently move muscles and joints to decrease pain and improve motion and strength
  • Movement re–education, which will include self–stretching techniques to help restore normal motion of the hip, back and legs; advice will also be offered on what stretches and movements should be avoided

There is large and growing body of evidence to support physical therapy as an effective intervention for a wide range of hip–related conditions. In one type of study called a systematic review and meta–analysis, researchers collected and analyzed all the available research on two commonly–used physical therapy interventions—manual therapy and exercise therapy—for hip osteoarthritis, one of the most common causes of hip pain. They identified a number of studies that backed up the proposed benefits of these interventions, finding that both exercise therapy and manual therapy reduced pain and improved physical function for patients with hip osteoarthritis.

Therefore, if you are currently impacted by hip pain of any sort that is complicating your daily life, we advise you to give us a call. Let us help you with an individualized treatment program to help empower you and regain your function by using your own capacity for movement.

The three most effective exercises to reduce your risk for hip pain
July 21, 2020

As we saw in our last newsletter, there are a number of issues that can develop in the hip that can go on to cause pain and dysfunction. These problems can strike at any age, but are more likely to develop later in life and in females, as the highest incidence of hip pain occurs in women aged 40-60 years.

In most cases, a combination of age-related changes and overuse are to blame, while traumatic injury may be the culprit for some patients. Whatever the cause, the toll that hip pain takes is often quite similar, as patients will variably lose their ability to move and function freely. Walking, running, and sitting/standing typically becoming more challenging, and these limitations will only persist if no interventions are taken.

While it’s not possible to reverse or stop natural age-related changes, there are several steps you can take to lower your chances of experiencing hip pain. One of the most beneficial tactics is to regularly perform exercises that focus on the muscles and joints of the hip and its supporting structures. Doing so will improve the strength and flexibility of the hip joint, which will lead to less strain and better overall functioning that equates to a reduced injury risk. Below are the three best exercises to prevent hip pain:

NOTE: Before you try these or any other exercise program, please consult with your physical therapist or physician.

  1. Supine hip flexor stretch
    • Lie flat on your back on a bed with one leg hanging over the side
    • Pull your opposite knee tight toward your chest until a comfortable stretch is felt
    • Hold this stretch for 30 seconds
    • Complete three repetitions on each leg
  2. Sitting piriformis stretch
    • While sitting on a chair, cross one leg over your opposite knee
    • Slowly bend your body forward until a comfortable stretch is felt
    • Hold this stretch for 30 seconds
    • Complete three repetitions on each leg
  3. Supine piriformis stretch
    • Lie on your back on the ground
    • Bend one knee up and grab it with your opposite hand
    • Pull your leg across your body, toward your shoulder, until a comfortable stretch is felt
    • Hold this stretch for 30 seconds
    • Complete three repetitions on each leg

Regularly performing these stretches will keep your hips mobile and your risk for hip pain down. But if problems do still manage to arise, it’s best to consult with a physical therapist, who will perform a comprehensive evaluation and design a personalized treatment program that’s suitable for your needs, abilities, and goals.

Hip pain can arise from sudden trauma, overuse, or age-related changes
July 14, 2020

The hip is a resilient joint that is capable of handling lots of activity and repeated movements, and it can sustain a significant amount of wear and tear. This durability exists because of its complex and multifaceted anatomy that we described in our last newsletter.

But despite these strengths, the hip has a concrete set of limits and is not invulnerable. Repeated activity, not taking enough time to recover, and age can all bring the hip closer to these limits, and when pushed beyond them, the result is injury or pain.

There are a number of conditions that can affect the health of the hip and prevent it from functioning normally, but several problems are seen more frequently due to movement patterns and behaviors that occur in the greater population. Below are 5 of the most common hip-related conditions:

  1. Femoroacetabular impingement
    • Arises when small bony projections (bone spurs) develop along either the femur or acetabulum, causing these bones to rub against each other directly without protection
    • Over time, the resulting friction between these two bones can damage the joint, which will cause symptoms like pain or stiffness in the groin or outside the hip that grows worse with turning, twisting, or squatting motions
  2. Labral tear
    • A rip in the labrum, which covers the acetabulum and secures the femoral head in place
    • The labrum can be torn by sudden trauma or repetitive motion and overuse in sports like hockey, golf, and soccer, age-related changes, structural problems, or some combination of these factors
      • Femoroacetabular impingement can also damage the labrum and lead to a tear over time
    • Symptoms are similar to femoroacetabular impingement and can include pain or stiffness, pain in the buttocks area, a clicking or locking sound in the hip, and feelings of instability
  3. Arthritis
    • Rheumatoid arthritis and osteoarthritis are among the most common causes of hip pain
    • While the course both these conditions take is slightly different, both involve the wearing away of the cartilage that surrounds the ends of bones in the hip joint, resulting in less protection and eventually friction between them as it progresses
    • Symptoms include pain, swelling, tenderness, and stiffness, and a general inability to move the hip and perform routine hip-related activities
  4. Hip bursitis
    • Each hip joint contains two bursae (singular bursa), which are fluid–filled sacs that ease friction between the bones, muscles, and tendons that comprise it
    • Bursitis is the inflammation of one of these bursa, which is typically due to repeated overuse or strain of the hip
    • The primary symptom is a dull, burning pain on the outer hip that’s made worse with excessive walking or climbing stairs
  5. Hip tendinitis
    • Inflammation of any of the tendons that flex the hips
    • Usually caused by repetitive strain and overuse, often from sports or other forms of physical activity
    • Symptoms include pain that develops gradually over time, tenderness, and stiffness in the morning or after long periods of rest

Read our next newsletter for a breakdown of the three most effective exercises that will help you avoid hip pain.

The crucial role the powerful hip joint plays in most body movements
July 7, 2020

The hip is one of the most versatile and important joints in the body. It’s extremely powerful due to its robust architecture, which also provides it with impressive stability. But the hip joint is also incredibly flexible, allowing for a massive range of motion that is second only to the shoulder in this capacity.

The hip connects the lower extremities to the trunk of the upper body, and its primary function is to bear the body’s weight during both static (eg, standing) and dynamic (eg, walking and running) postures. Bones, cartilage, muscles, ligaments, tendons, and other structures all work together to allow this to occur.

Bones and cartilage The hip is a ball-and-socket joint—the largest in the body—that is comprised of the head of the femur and the acetabulum.

  • Femur: the upper leg bone that connects the knee to the hip; longest and heaviest bone of the body; it has a long shaft and head (femoral head) that serves as the “ball” of the hip joint
  • Acetabulum: a deep, cup-shaped depression of the pelvis bone that serves as the “socket” of the hip joint
  • Cartilage
    • Articular cartilage: the femoral head and acetabulum are covered in articular cartilage at their ends where they meet, which is a strong, slippery, flexible material that allows them to glide smoothly without coming into contact with each other
    • Labrum: a strong piece of cartilage that forms a ring around the outer edge of the acetabulum; it deepens the socket of the pelvis and acts as a gasket to provide the hip with more stability, but it is also elastic to permit greater flexibility


Large, thick muscles of the buttocks and thighs surround the hip and are responsible for the significant amount of power that the joint can generate. These muscles are typically classified into four groups—the gluteal group, adductor group, iliopsoas group, and lateral rotator group—based on which directions they permit movement in. The complex anatomy of the hip gives it the ability for three distinct types of movement:

  • Flexion and extension: moves the leg back and forth
  • Abduction and adduction: moves the leg out to the side (abduction) and inward toward the other leg (adduction)
  • Rotation: moves the toes inward (internal rotation) or outward (external rotation)

Ligaments and tendons

The bones and muscles of the hip are all connected by a number of ligaments and tendons that further reinforce the joint’s strength while also preventing each structure from moving too far in any direction. The iliofemoral ligament is the strongest in the body and it prevents excessive adduction and internal rotation, while the pubofemoral ligament restricts abduction and the ischiofemoral ligament prevents internal rotation.

Synovial fluid

Lastly, a synovial membrane encapsulates the entire hip joint, which produces synovial fluid that lubricates and circulates nutrients to the hip. This fluid is stored in the cartilage while at rest but is squeezed out when the hip rotates or bears weight so that it moves more smoothly. As a result, it’s necessary to move the hip frequently to keep it healthy and lubricated.

These structures collectively help to keep the hip strong, stable, and flexible, but as we’ll explore in our next newsletter, problems can occur when any of these components break down or fail to properly perform its function.

For persistent back pain, physical therapy is your best choice
June 25, 2020

Most cases of low back pain are short-lived—or acute—and only last for a few weeks before gradually subsiding. Getting regular physical activity and performing targeted strengthening exercises will further facilitate the healing process, and many patients are able to experience significant improvements without any professional intervention.

But for others, the pain does not improve over time, even after making lifestyle changes and increasing physical activity levels. Persistent low back pain that lasts for more than three months is categorized as a “chronic,” which usually means that additional strategies are needed. There are also many patients that aren’t comfortable performing exercises at home without guidance and who may require a more hands-on approach to managing their condition.

For anyone that falls into either of these groups, a more structured treatment program is required, and physical therapists are the professionals best equipped to provide this in a safe and effective manner. Physical therapy uses a variety of movement-based interventions for low back patients, some of which the patient executes independently with guidance, and others that the therapist carefully performs. The ultimate goal of each component of treatment is to teach patients how to move better in order to reduce their pain levels, increase function, and prevent further recurrence.

Seeing a physical therapist as the first point of care for low back pain can also help patients avoid other expensive or unnecessary interventions in the future. Research has shown that individuals who undergo early physical therapy are less likely to have surgery or injections for their pain, and it has also been found to reduce costs, healthcare use, opioid use, and improve health care efficiency.

Each low back pain treatment program is tailored specifically to the patient’s needs, abilities, goals, and preferences, but there are certain features that most share in common. A typical treatment program for low back pain will consist of the following:

  • Passive interventions (performed by the therapist)
    • Ice and/or heat therapy
    • Ultrasound
    • Manual (hands-on) therapy
  • Active physical therapy (performed by the patient)
    • Stretching exercises for the buttocks, back, spine and hamstrings are helpful for keeping joints flexible and should be done twice a day
    • Strengthening exercises are needed to build the muscles in the back and core, and should be done for 15-20 minutes every other day
    • Low-impact aerobic exercises like walking, biking and swimming are also important and should be done for 30-40 minutes, three times a week
  • Education: physical therapists will also provide tips and guidance on how to improve your posture and make other necessary changes that may be contributing to your pain

Low back pain is one of the most common conditions in all of healthcare, and it often becomes a burden for the countless individuals who are impacted by it. But as you can see, there are a number of ways you can take control of your situation and make changes that will greatly benefit you. If you are suffering from back pain give us a call and together we will build a personal plan that addresses your individual need.

Three good strengthening exercises to support your lower back
June 16, 2020

As we explored in our last newsletter, low back pain is overwhelmingly common, with tens of millions of Americans impacted by symptoms at this very moment. Each person’s situation is unique and the severity of these individual’s back pain varies, but most frequently experience some degree of disability or limitation that interferes with their normal way of life.

One of the many consequences of having low back pain is that it often reduces physical activity levels. Whether it’s not accepting an invitation to play a pickup game of basketball or avoiding yard work that involves lots of bending and twisting, a sizable portion of low back pain patients will notice a decrease in movement because of their condition. Unfortunately, moving less can actually increase pain levels, making it even more difficult to move and initiating a challenging cycle of pain and inactivity.

On the flip side, moving more and staying active is one of the best things you can do for your pain. Although it might seem sensible to avoid any motions that could lead to pain, the truth is that regular physical activity is crucial because it helps to keep your muscles strong and joints flexible. Exercise will also increase blood flow throughout the body and specifically to the lower back area, which may reduce stiffness and speed up the healing process.

Activating the lower back and core muscles can help with support and stability for the spine, which in effect leads to less strain and less pain. With this in mind, we present the three best strengthening exercises for your low back and hip muscles.

NOTE: before you try these or any other exercise program, please consult with your physical therapist or physician.

  1. Glute bridge (bridging)
    • In addition to the lower back, this exercise strengthens the hamstrings, gluteal muscles (buttocks), and hip muscles; to perform this exercise:
      • Lie with your back to the floor, knees bent with only your feet on the floor
      • Dig your heels into the floor a bit and squeeze down on your gluteal muscles
      • Lift your hips up until they are 6–8 inches off the ground and hold this position for about five seconds
      • Slowly bring your hips back to the floor and give yourself about 10 seconds of rest
      • Repeat 8–12 times
  2. The Bird Dog
    • Bird Dog is a great way to learn to stabilize the low back during movements of the arms and legs; to perform:
    • Get on your hands and knees and tighten your abdominal muscles
    • With one leg, lift and extend it behind you while keeping your hips level; lift and hold the alternate arm out in front of you; hold for 5 seconds
    • Switch to the other leg and arm. Repeat 8–12 times per side.
    • For an added challenge, try lengthening the time you hold each lift
  3. Lying lateral leg lift
    • This exercise strengthens the hip abductor muscles, which support the pelvis and can help reduce strain on the back; keeping these muscles strong can also help you maintain balance and improve stability; to perform
    • Lie on one side with your legs together and lower leg slightly bent
    • Bring your bellybutton into your spine to engage the core muscles
    • Raise your top leg about 18 inches, keeping it straight and extended; hold the position for 5 seconds
    • Repeat 10 times
    • Turn onto the other side of the body and repeat, lifting the other leg
    • Perform 2 sets on each side

In our next newsletter, we’ll look into the role that physical therapy can play when low back pain persists after performing these exercises and for patients that require a more hands–on approach to their condition.

If your back hurts, a diagnosis may not be the best path
June 9, 2020

Low back pain is jarringly common. About one-half of all working Americans will experience symptoms at least once every year, and roughly 31 million are affected by it at any given point in time. So if you find it appropriate to place yourself in this category, you’d have an abundance in company.

Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something off the ground or twisting your torso when looking to the side might suddenly give you pause and make you less mobile in the process. This development naturally leads to frustration and often shifts to a focus on one main question: “what’s causing this pain?”

As a result, many patients with low back pain start to place a particularly strong—and sometimes unhealthy—emphasis on obtaining a diagnosis. They usually believe that doing so will clearly explain why they are in pain and will allow the right treatments to be performed. Sadly, searching for a diagnosis for low back pain is complicated and often does not lead to the outcomes that most patients hope for. And in many cases, it can do more harm than good.

Why ‘abnormal’ is a relative term

In their hunt for a diagnosis, many patients will decide to have an imaging test performed, which include X-rays, MRIs, and CT scans. These types of tests serve an integral role in diagnosing a plethora of conditions throughout the body, but when it comes to low back pain, their usefulness is not as certain. The primary issue is that an imaging test should serve as only one component of reaching a diagnosis, in addition to a detailed patient interview and thorough physical examination. But many patients—and some doctors—rely too heavily on the results of the test instead.

In addition, the results from these tests are not always as clear-cut as one might assume. Many individuals who don’t have any low back pain symptoms will have “abnormal” findings on an imaging test, while many of those with symptoms will test results that appear to be completely “normal.” To put matters in perspective, below is a brief summary of the findings from an important study that reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain:

  • 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
  • 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
  • 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these findings increases significantly with age. When not explained properly and interpreted in the context of an examination and other factors, a patient with back pain may incorrectly believe that these “abnormal” findings are the same thing as a diagnosis, when they may instead be a sign of the natural aging process. The words “bulging” and “degeneration” also tend to create scary images of the spine that could further alarm patients and push them towards undergoing interventions like surgery to fix the problem, even though their results may have nothing to do with their pain.

It’s important to point out that there are several diagnoses that are extremely important and require careful medical intervention, some of which an imaging test will assist with. Spinal tumors, cauda equina syndrome, spinal infection, abdominal aneurysm, and ankylosing spondylitis are among the conditions that typically lead to severe symptoms, but none of these are very common. Two other signs that something more serious could be present are incontinence and or numbness around the groin and buttocks, and any accident that could have fractured the spine. If either of these signs accompany back pain, it’s imperative that you seek out immediate medical attention.

But in the vast majority of cases, patients with low back pain should focus more on addressing their condition with a movement-based strategy and less on obtaining a diagnosis, which is not the silver bullet they might be expecting. In our next newsletter, we’ll provide you with some strengthening exercises that you can perform to alleviate your low back pain on your own.

Your back is built for durability and flexibility
June 2, 2020

The anatomy of your spine is rather remarkable. Its complex design includes a combination of strong bones, large muscles, and flexible ligaments and tendons, which are all interconnected in a manner that provides both extreme durability and flexibility. This means the spine is strong and sturdy—so it can support the rest of the body and protect the structures within it—but is also highly flexible, allowing for mobility in several directions. These two characteristics are defining features of the spine, and they show that it’s far more resilient than one might think.

Below, we break down the primary structures of the spine—particularly in the lower spine—responsible for these characteristics:


  • The spine is made up of 33 bones called vertebrae (singular vertebra), which are stacked together and interlocked to form the spinal column
  • Only the top 24 bones are moveable—those of the sacrum and coccyx at the base of the spine are fused—and these vertebrae are numbered and divided into three groups:
    • Cervical (upper back) region
    • Thoracic (mid-back) region
    • Lumbar (lower back) region
  • The lumbar region consists of five vertebrae (L1-L5), which are much larger than the bones above it and progressively increase in size going downwards; the function of these bones is to support the weight of the body, and their size allows them to absorb the stress of lifting and carrying heavy objects

Facet joints

  • These vertebrae are connected in the back of the spine with a small pair of joints called facet joints
  • They add to the spine’s stability and allow the spine to move in several directions
  • The facet joints of the lumbar spine are more flexible than those of the cervical and thoracic spine, and they make side—to—side movements easier to perform

Intervertebral discs

  • In between each vertebra is a structure called an intervertebral disc
  • These discs consist of a tough outer portion (annulus fibrosus) made up of collagen fibers that surrounds a soft inner core (nucleus pulposus), which is filled with a jelly-like substance
  • The purpose of the discs is to absorb shock, hold the vertebrae together and prevent them from rubbing against one another during movement


The lower back also consists of a large and complex group of muscles that work together to support the spine, help the body remain upright, and allow the trunk and body to move, twist, and bend in several directions. The three main types of muscles in the lower spine that help with these functions are the following:

  • Extensor muscles: these muscles attach to the back of the spine and allow you to stand and lift objects; they include the erector spinae, which is a large pair of muscles that that helps to hold up the spine
  • Flexor muscles: these muscles attach to the front of the spine and allow you to bend forward, flex, lift, and arch the lower back
  • Oblique muscles: these muscles attach to the side of the spine and help to rotate the spine and maintain proper posture

Collectively, these structures help to make the spine one of the sturdiest structures in the body, while also permitting an extensive range of motion. Unfortunately, pain is the lower back is extremely common, but as we’ll explain in our next newsletter it usually doesn’t mean there is necessarily anything wrong with the spine.