Few conditions can compete with back pain when it comes to prevalence. As one of the most common reasons for visiting a doctor, about 25% of Americans have dealt with low back pain in just the past three months, and up to 80% of the population will encounter it at least once in their lives. This unfortunately means that if you’ve never had a bout of back pain, there’s a strong chance that you will at some point in the future.

But you don’t need to worry. If you’re dealing with back pain now or it strikes down the road, you can take solace in knowing that most cases will eventually improve without the need for any drastic measures. Read on for a closer look at low back pain through a series of frequently asked questions about what usually causes back pain, why the cause is not usually very important, and what you should do if you’re affected by it.

Q: What conditions can cause my lower back pain?

A: The list of conditions that can lead to low back pain is extensive, but some of the most common causes include sprains and strains, spinal stenosis, a herniated disc, joint issues, and degenerative disc disease. To understand how these conditions affect the spine and surrounding structures, we first need to give a quick anatomy lesson.

The spine consists of 33 bones called vertebrae, which are stacked on top of one another and interlocked to form the spinal column. The vertebrae are connected by small joints that allow the spine to move in various directions, and in between each vertebra is a structure called an intervertebral disc. These discs consist of a tough exterior and are filled with a jelly-like substance, and their purpose it to absorb shock and prevent the vertebrae bones from rubbing against each another.

• Sprains and strains: sprains involve ligaments and strains involve muscles; both are injuries that result from these structures being pushed beyond their limits, either from a single incident or due to repeated stress over time
• Spinal stenosis: a condition in which the spinal canal narrows, which puts pressure on the spinal cord; it usually occurs later in life
• Joint dysfunction: a term used to describe when any of the joints of the spine—including the facet joints or sacroiliac joint—are not working properly
• Herniated disc: a condition in which the softer jelly-like substance of the intervertebral disc pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact
• Degenerative disc disease: an age-related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to disc herniation and other problems

Q: Is it essential to identify what’s causing my lower back pain?

A: In most cases, no. While it’s good general knowledge to be aware of these common causes of low back pain, the truth is that getting an accurate diagnosis is usually less important than you might think, especially when the pain is not chronic. For starters, because the anatomy and mechanics of the spine are so complex, only about 20% of patients of back pain actually end up receiving a specific diagnosis. In addition, most cases of low back pain are managed with a fairly similar set of treatments, regardless of what condition is believed to be responsible. This is because low back pain is typically approached based on the symptoms present rather than the exact malfunction of the spine.

But there are certain situations when obtaining an accurate diagnosis may be necessary. The biggest concern is that a more dangerous condition or disease is causing low back pain, and if so, it may require immediate treatment. These are generally the same indications that warrant a diagnostic test like an MRI for low back pain (discussed next) and include severe neurological symptoms and other red flags that could suggest an infection, spinal fracture, cancer, or a condition called cauda equina syndrome. These problems only account for a very small percentage of low back pain cases and are unlikely to be responsible, but your healthcare provider will remain aware of the risk for them nonetheless.

Q: Do I need to get an MRI right away?

A: Probably not. As we described above, MRIs are only recommended in rare cases when there is suspicion of a potentially dangerous diagnosis. In the absence of any of these red flags, an MRI will not do much good, and can actually lead to unnecessary treatments that may not address the pain. The reason is that “abnormal” findings from MRIs and CT are extremely common, as one study found that 80% of 50-year-olds and 96% of 80-years-olds with no back pain symptoms had signs of disc degeneration on their imaging tests. This shows that the imaging test usually does not reveal the source of the pain, which means that repairing a herniated disc may not truly fix the problem.

Q: What if I have a herniated disc?

A: Understand that many other people have the same condition, and as we’ve just explained, and it may not be responsible for pain. And if you do have low back pain and a herniated disc, that still doesn’t guarantee that it’s the cause of your symptoms. Plus, most herniated discs eventually regress—or heal—on their own when surgery is not performed. This is why the best thing to do is to address the pain through treatments like physical therapy while avoiding surgery.

Q: What should I do after I experience low back pain?

A: First off, don’t panic! The prognosis for low back pain is good, and most cases will eventually get better regardless of what’s done to address it. But there are certain steps you can take to increase the chances of making your pain subside, such as:

• Stay physically active and avoid too much bed rest
• Try returning to normal activities as soon as possible
• For persisting pain, try nonsteroidal anti-inflammatory drugs
• Avoid opioids under most circumstances, as these drugs are frequently associated with misuse, abuse, and dependence
• Consider seeing a physical therapist to get started on treatment early, which we’ll discuss in more depth later

Q: Should I see a physical therapist?

A: Absolutely! We can’t be any clearer about this one. Physical therapy addresses the symptoms of low back pain right away and is one of the safest and most effective options to reduce pain and help patients regain their function. Read our last post of this series for a closer look into physical therapy.

Inflammation is one of the body’s greatest weapons. When a foreign substance enters your body—through an infection, injury, or some other cause—the immune system kicks into action and sends out inflammatory cells that are capable of containing the threat and protecting the body from any further damage. Any time you’ve experienced the typical symptoms of a cold or noticed redness and pain after getting a paper cut, these signs of inflammation are completely normal and natural, and show that the immune system is doing its job by fixing the problem and keeping you safe.

But that’s not to say all inflammation is good. Inflammation is only meant to occur when a real threat is detected, and then it should stop after the threat has been resolved. Too much inflammation, on the other hand, puts your body in a constant state of high alert, which is dangerous. Many health conditions are associated with chronic inflammation, including heart disease, diabetes, Alzheimer’s disease, autoimmune conditions, arthritis, obesity, and several types of cancer. As such, keeping your inflammation levels in check is often considered a chief component of healthy lifestyle.

The encouraging news is that you have the power to partially control your inflammation levels. Smoking, excessive alcohol intake, and being overweight or obese can all lead to increased inflammation and should therefore be avoided, but your diet plays a major part in the inflammatory process as well. A rapidly growing body of evidence has shown that there are many foods that have anti-inflammatory effects and that following a diet rich in these foods can reduce the risk for a range of health conditions and death. Among the many reported benefits of an anti-inflammatory diet are the following:

• Less joint damage, delayed disease progression, and possibly less reliance on medication in patients with rheumatoid arthritis
• A lower risk of dying in smokers from any cause, particularly heart disease
• Faster recovery after athletic training
• Better management of pain associated with aging
• Heart protection
• Improved quality of life for patients with multiple sclerosis

Four foods that help fight inflammation

Perhaps the best part about an anti-inflammatory diet is that it’s involves a great deal of common sense and overlaps with many other common dietary recommendations. Foods that generally increase inflammation levels also happen to be foods that are generally regarded as “unhealthy.” These include:

• Refined carbohydrates like white bread, pastries, and sweets
• Red meat and processed meat like hot dogs and sausages
• Fried foods
• Foods and beverages with high sugar content
• High-fat dairy products
• Foods with high saturated fat content

It may not surprise you to hear, then, that many of the foods that are found to have anti-inflammatory effects are also foods that are generally perceived regarded as “healthy.” Unprocessed, natural, fresh foods like fruits, vegetables, and legumes, as well as whole grains, healthy fats, and herbs and spices, are all considered anti-inflammatory, which highlights the diverse array of options that fall under this umbrella. To better guide you, here are four foods and food items that you may want to consider introducing to your diet based on their anti-inflammatory properties:

Turmeric: research has shown that turmeric contains many compounds that exhibit both anti-inflammatory and anti-cancer activities, including curcumin, which is the chemical that gives this spice its bright yellow color; in addition to alleviating inflammatory conditions, turmeric has also been found to reduce the activity of Alzheimer’s disease in patients who have this condition. Mushrooms: many mushrooms contain compounds with a host of beneficial properties, including the capacity to reduce inflammation; mushrooms are also low in calories and fat but high in polyunsaturated fats, which adds to their beneficial health profile. Fatty fish (salmon, tuna, mackerel, and sardines): these fish are all extremely high in omega-3 fatty acids, which are capable of slowing down or stopping many aspects of inflammation; fish oil supplements are also loaded with omega-3s and can be taken daily. Flaxseed: flaxseed is another rich source of omega-3 fatty acid, and adding this to one’s diet has been associated with a host of health benefits, including a reduced risk for cardiovascular disease and cancer, as well as improvements to gastrointestinal health and diabetes.

Disclaimer: physical therapists are not licensed to provide nutrition recommendations, and this post is intended for informational purposes only.

In our first post, we discussed three of the most common conditions that occur in the lower leg and answered some frequently asked questions about these issues. Next, we walked you through three key exercises that you can perform on your own to alleviate pain related to several common lower leg conditions. As we pointed out, regularly performing stretching and strengthening exercises can lead to notable gains for many patients, but there are limits to these benefits.

For pain and functional limitations related to shin splints, Achilles tendinitis, or plantar fasciitis that persists after you’ve tried to correct it independently, additional care from a trained professional is needed. The clearest answer to this call is physical therapy. Physical therapists are movement experts who help patients overcome their impairments with a multifaceted treatment approach, and they are your best option available for each of these common lower extremity conditions.

Research has shown that many of the interventions frequently utilized by physical therapists are effective for addressing these disorders and are featured in the relevant treatment guidelines as a result. For example, the clinical practice guidelines for plantar fasciitis assign an “A” grade to stretching, manual therapy, taping, and foot orthoses, which are some of the most commonly used physical therapy interventions for this condition. An “A” grade means that there is “strong evidence” to support the recommendation for these therapies. Another study found that patients with plantar fasciitis who received manual—hands-on—therapy from a physical therapist averaged fewer visits and lower costs than those who did not.

Similarly, the clinical practice guidelines for Achilles tendinopathy—an umbrella term that includes Achilles tendinitis and tendinosis—assign an “A” grade to exercise, a “B” grade to activity modification, and a “C” grade to stretching exercises. Other research has also found exercise to be the primary treatment strategy for Achilles tendinopathy, particularly eccentric exercise, which is the gold standard for this condition (and will be discussed later).

An overview of physical therapy for shin splints, Achilles tendinitis, and plantar fasciitis

While there are certain interventions consistently used for these conditions, each physical therapy treatment program will be unique based not only on the specific disorder, but the patient’s needs, abilities, and goals as well. Below is a brief summary of the treatments most commonly utilized to address each of these conditions:

Shin splints

• Strengthening exercises: one way to decrease stress on the lower leg is by increasing the strength of the muscles associated with the hip; therefore, hip rotation, hip abduction, and hip extension strengthening exercises are frequently prescribed
• Strengthening exercises can also be performed to increase your arch and shin muscle strength to decrease the overpronation (flattening out) of the arch of the foot
• Stretching exercises: these typically target the calf and foot muscle
• Balance exercises: the single-leg stance progression exercise, as well as squats and heel raises can all help to improve balance
• Footwear education: your therapist may provide suggestions for your footwear to ensure that your feet are fully supported when walking and exercising
• Shoe orthotics or inserts: your therapist may prescribe these if your feet flatten out too much or if your foot muscles are weak to better support the arch of your foot

Achilles tendinitis

• Eccentric calf-strengthening exercises: these exercises lengthen a muscle at the same time it’s being contracted and are strongly recommended for Achilles tendinitis; the best example is the heel drop
• Heel drop: stand on the edge of a stair or stable platform—with one or both feet—and hold on to a rail to keep your balance; lift your heels off the ground, then slowly lower them to the lowest point possible in a controlled fashion; repeat this step 20 times; weights can be added
• Manual therapy: these hands-on techniques administered by a physical therapist include massage, manipulation, and mobilization, which improve mobility and function, and alleviate symptoms
• Stretching exercises: the physical therapist will usually guide you on how to stretch tight muscles in order to improve flexibility and range of motion; patients, in turn, can perform these exercises on their own at home
• Pain-relieving modalities: ice, heat, ultrasound, and other passive interventions may also be used to reduce pain and inflammation

Plantar fasciitis

• Stretching and strengthening exercises: the primary muscles targeted are those of the calves, ankle, and foot, including the plantar fascia
• Foot taping and/or a night splint: these techniques provide support for the arch of the foot
• Footwear education: as with Achilles tendinitis, your footwear selection can affect the progression of plantar fasciitis, and your therapist can guide you on how to select the right pair of shoes that reduce stress to the plantar fascia
• Pain-relieving modalities: heat, ultrasound, and icing the bottom of the foot can all lead to immediate pain relief
• Manual therapy: massage and manual techniques can release muscle tension in the foot and surrounding area and reduce pain

With a clear set of benefits and a treatment approach that will be unique to your condition, physical therapy is the fastest and safest way to a complete recovery. So if you’re bothered by any lingering pain in your lower leg, contact a physical therapist to get started on your rehabilitation right away.

Lower extremity issues like shin splints, Achilles tendinitis, and plantar fasciitis are fairly common, particularly in individuals who are physically active. The gradual development of pain and resulting physical limitations often take a toll on these patients, only minimally at first, and then significantly over time. Eventually, painful symptoms have the potential to slow down or completely stop an individual from participating in their exercise or activity of choice, which can lead to further physical and mental repercussions.

One of the most effective ways to address musculoskeletal pain is by systematically stretching the structures involved, and that principle applies to each of these conditions. Shin splints, Achilles tendinitis, and plantar fasciitis are all overuse injuries that stem from overtraining without taking sufficient time to recover, and muscle tightness or stiffness is a common feature that can also exacerbate painful symptoms. Therefore, regularly lengthening certain muscles with targeted stretches can cause them to function more efficiently and reduce the strain on painful tendons and muscles. Strengthening and balance exercises can also help. With this in mind, we present three of the best stretches and exercises that you can perform independently to reduce pain from these common lower extremity conditions:

Gastrocnemius/soleus stretch

• The gastrocnemius is the big, bulky muscle of the calf that spans from the lower end of the thighbone (femur) to the back of the heel, where it connects to the foot through the Achilles tendon; it allows you to push your foot downwards—which is called plantar flexion—and helps you bend your knee
• The soleus is a long, flat muscle that lies behind the gastrocnemius, along the back of the shinbone (tibia); it also helps to plantar flex the foot—especially when the knee is bent and the gastrocnemius is being used—and helps to keep the body upright when standing
• The stretch: this is a two-part stretch, with each part stretching one of the two main calf muscles, and it can be used to address pain from all three conditions
• 1) Gastrocnemius stretch: lean on a wall or chair and place the leg being stretched behind you, pointing forward and kept straight; next, tighten your thigh muscles and gradually lean forward by bending your elbows, with the heel of your foot always touching the ground; just before your heel lifts from the ground, stop and hold the stretch for 10 seconds; repeat three times
• 2) Soleus stretch: position your body as you did for the gastrocnemius stretch, but bend your back leg at the knee instead of keeping it straight; move your hips further from the wall and drive your back knee toward the ground while keeping your heel on the ground; just before your heel lifts up, stop and hold the stretch for 10 seconds, try to allow your lower calf muscles to relax during the stretch; repeat three times

Single leg stance progression exercises

• Balance is incredibly important for athletes and active individuals, and having poor balance can be a contributing factor to many overuse injuries; in essence, if you can’t comfortably stand on one leg—which is called static single leg stability—the structures of your lower leg will be less capable of handling the normal demands of activity, and this can result in pain
• Therefore, increasing your single leg balance can help alleviate pain from various lower extremity issues, especially shin splints
• The exercise: stand upright with your feet together and position yourself behind a chair or next to something stable like a countertop; hold onto the back of the chair with both hands, then slowly lift one leg off the ground and don’t allow your legs to touch; maintain your balance while standing on one leg for 5 seconds, then return to the starting position and repeat 5 times; try to gradually increase the amount of time you spend standing on one leg
• Variations: as you increase the duration of this exercise and become more comfortable, you can introduce variations like performing the exercise with your eyes closed, raising your heel, or catching and tossing a ball thrown by someone else

Plantar fascia stretch

• Tight muscles in your calves or feet can exacerbate plantar fasciitis, and the resulting pain can lead to reduced physical activity, which further contributes to muscle stiffness; therefore, stretching the plantar fascia and surrounding structures is one of the most effective ways to alleviate pain from plantar fasciitis
• The stretch: while seated, cross your painful foot over your thigh and let it hang; place your fingers along the base of the toes, then gently bend your foot back into extension, stretching the plantar fascia; hold the stretch for 10–15 seconds, then release; repeat five times

In our next post, we’ll explain why it’s usually best to see a physical therapist if you continue to be bothered by lower leg pain you even after trying these exercises.

The lower portion of your body is tougher than you might realize. Your lower leg, ankles, and feet have the tall task of bearing the brunt of your entire bodyweight any time you perform an activity that involves standing. So it’s easy to see that these forces can be rather substantial. As a result, the structures that support these regions are designed to be strong and durable in order to handle the regular, significant strain that is placed on them.

But extreme durability does not mean invincible, and there are limits to what these structures can do. When the lower leg, ankles, or feet, get overworked or over-trained, or if they aren’t strong or flexible enough to handle the demands placed on them, problems can arise that typically lead to injury and pain. There are many painful conditions that may develop in this region of the body, and most are considered overuse injuries that usually develop gradually from improper load management or training mistakes. Three of the most common lower extremity issues are shin splints, Achilles tendinitis, and plantar fasciitis, and below, we discuss some key details about these disorders by answering a series of frequently asked questions.

Q: What causes shin splints?

A: Medial tibial stress syndrome, more commonly referred to as shin splints, is a condition that develops when too much stress being placed on the tibia (shinbone). There are several muscles that attach to the tibia and provide it with support, including the posterior tibialis, soleus, and flexor digitorum longus muscles. Shin splints occur when any of these muscles is overworked, usually from repeated activities or after suddenly increasing the duration, frequency, or intensity of your workout. This leads to strain on the tibia and causes the muscles to also become strained at their insertion on the bone. The most common symptom is pain in the middle or bottom third of the inside of the shin, which usually gets worse with activity and decreases with rest. Runners and athletes involved in sports with lots of running are at the highest risk for developing shin splints, while those with flat feet or high arches also have an elevated risk.

Q: What can I do to relieve shin splint pain?

A: There are a number of changes you can make to your exercise routine and daily life to help you avoid further aggravation of the tibia and reduce your pain levels. We recommend the following:

• Take a break from physical activity and exercise, which can exacerbate your pain
• Apply ice to your shins for 5–10 minutes, 1–3 times a day
• Gently stretch the muscles around your shin or try self-massaging the region
• Always wear properly fitting shoes, especially while running or exercising; go to a specialty shoe store to have your gait analyzed, which will help you determine which shoes are best
• Slowly and gradually build your fitness level and avoid making extreme changes to your exercise regimen
• If you are an avid runner, try integrating some cross-training into your exercise routine like swimming or biking to reduce pressure on your legs

Q: What is Achilles tendinitis?

A: The Achilles tendon connects the calf muscle to the heel bone. It is the largest and strongest tendon in the body, and is capable of withstanding loads of up to 2,000 pounds when running. Achilles tendinitis is an extremely common overuse injury that involves inflammation of this tendon. It occurs most frequently in runners, particularly those who do lots of speed training or uphill running, or after suddenly increasing the intensity or duration of runs without ample recovery. This constant strain causes small micro-tears in the Achilles tendon and eventually leads to the characteristic inflammation and resulting symptoms. Most patients with Achilles tendinitis experience pain that comes on gradually as a mild ache in the back of the leg or above the heel, which may get worse after running or climbing stairs.

Q: What’s the difference between Achilles tendinitis and Achilles tendinosis?

A: Tendinitis means “inflammation of a tendon,” while tendinosis is a term used to describe a chronic—or long-term—tendon injury. Thus, if a patient has Achilles tendinitis and doesn’t address it or change their routine, it will further strain and damage of the tendon. Over time, this repeated trauma can lead to Achilles tendinosis, which is a more serious condition. Unlike tendinitis, inflammation is no longer present, but the damaged Achilles tendon instead becomes hard, thickened, and scarred. There is also degeneration at the cellular level in tendinosis that can include changes to the structure of the tendon, which does not occur in tendinitis. Together, this results in a loss of strength and can lead to further injury.

Q: What is plantar fasciitis?

A: The plantar fascia is a thick, connective band of tissue that runs across the bottom of the foot and connects the heel to the toes. It’s a tough structure designed to absorb significant forces from standing, walking, and running, but can get damaged when it takes on too much stress. The result is a condition called plantar fasciitis, or inflammation of the plantar fascia, which is the most common cause of heel pain. This typically results in a stabbing pain near the heel that’s most noticeable upon waking up and after standing for too long. Long-distance runners, individuals with flat feet or high arches, and those who are overweight or regularly perform any other weight-bearing activity are all at increased risk for plantar fasciitis.

Q: What other conditions can cause heel pain?

A: Although Achilles tendinitis and plantar fasciitis account for a significant proportion of all heel pain cases, they are not the only causes. Other conditions that may be responsible include the following:

• Intrinsic muscle strain: the intrinsic muscles are several smaller muscles located on the bottom of the foot, which support the arch of the foot and are sometimes referred to as the “core” muscles of this area; any of these muscles can become strained from overactivity, which leads to symptoms similar to plantar fasciitis
• Abductor hallucis tendinopathy: the abductor hallucis is another muscle that spans the arch of your foot, from the inner heel to the big toe; this muscle can be stressed when the foot continuously rolls inward and from other actions that strain the arch, which leads to tendinopathy; because the abductor hallucis covers a similar area as the plantar fascia, pain in this area is often mistaken for plantar fasciitis
• Heel bursitis: each heel has a bursa, which is a fluid-filled sac that cushions and lubricates the tendons and muscles that slide over the bone; this bursa can become inflamed from rapid increasing the intensity of one’s workout schedule, and the symptoms are often similar to those from Achilles tendinitis

In our next post, we’ll walk you through three key stretches that you can perform on your own to lower your pain levels from any of these conditions.

Myofascial pain syndrome is often a nagging problem that has the potential to impair one’s mobility and degrade quality of life. While strategies like improving your posture can reduce the chances of developing myofascial pain and at-home prevention measures like the “WITY” exercises can alleviate pain if it does arise, in some cases, the problem persists. For those with lingering myofascial pain that won’t seem to go away, additional interventions from a trained professional are usually needed.

Most experts agree that the best way to treat myofascial pain syndrome is by starting with conservative, natural care first because it is easy to access, affordable, and has little to no side effects. Physical therapists are the best first choice to treat myofascial pain syndrome because it utilizes a conservative/natural interventions that have been proven to be effective as reported in medical literature.

As with every other condition, physical therapists create treatment programs for patients with myofascial pain syndrome that are custom-tailored to each individual based on their specific set of symptoms, physical abilities, and goals; however, there’s a strong chance that certain interventions will be used because they are known to be beneficial for this condition. Below, we review some of the most commonly used physical therapy techniques for myofascial pain syndrome:

• Manual therapy: this hands-on treatment involves the physical therapist moving the joints and muscles in specific directions and at different speeds to increase their mobility, flexibility, and function; manual therapy is frequently used for patients with myofascial pain syndrome, and research has shown that it is one of the most effective techniques for this condition
• Myofascial techniques: this is a variety of manual therapy techniques designed specifically for myofascial pain syndrome; it can be performed with several different methods—including the Graston Technique and Active Release Technique—but the basic principle is always the same: the therapist uses their hands, elbows, and/or an instrument to relieve pain, loosen stiff muscles and fasciae with the goal of “releasing” them
• Stretching and strengthening exercises: structured exercise is a crucial component of any treatment program for myofascial pain syndrome, as it will help to increase flexibility and boost strength and stability in the muscles of the upper back and shoulders affected by trigger points; research has also suggested that targeted exercises can reduce neck pain from frequent computer use, which is associated with myofascial pain; therefore, your physical therapist will guide you on how to perform a variety of stretching and strengthening exercises—such as the “WITY” exercises described in our last post—that you can perform on your own at home
• Posture training: if your physical therapist determines that poor posture may be a contributing factor to your case of myofascial pain syndrome, they will work to identify any posture deficits present and help you correct them by practicing proper postures for all positions
• Electrical nerve stimulation: this is another modality in which an electric current stimulates nerve fibers to reduce pain levels; research suggests that it may be beneficial for myofascial pain syndrome, but should only be used in addition to other targeted interventions
• Dry needling: in this treatment method, the physical therapist will insert a thin needle directly into a region with a trigger point, which inactivates or “resets” the trigger point, thereby reducing tightness and alleviating pain; a number of studies have supported dry needling as an effective intervention for myofascial pain syndrome, and it is frequently used by appropriately trained therapists

Myofascial pain syndrome clearly has the potential to impair your function and impede your quality of life, but it’s important to recognize that you have options that can help you deal with it. Seeing a physical therapist early on will increase the chances of a successful outcomes and help you avoid future complications. For this reason, we recommend contacting your local physical therapist first and fast if you’re experiencing any issues that may be caused by myofascial pain syndrome.

As we’ve explained in this newsletter series, myofascial pain syndrome is a common condition that can affect any muscle in the body, but the muscles of the upper back, neck, and shoulder region have a particularly high risk of being involved. The deep, aching pain and stiffness that results from the characteristic trigger points in myofascial pain syndrome often then go on to impair one’s mobility and reduce quality of life in the process.

If you happen to notice symptoms that could be related to myofascial pain syndrome, it’s important to realize that this is a very treatable condition that responds well to many interventions. Targeted exercises are generally regarded as a mainstay of treatment and one of the best initial steps you can take if you’re dealing with upper back pain. When performed correctly and regularly, these exercises will increase the strength and flexibility of the muscles often associated with myofascial pain, thereby alleviating pain over time.

“WITY” exercises

We strongly recommend a set of four exercises that are usually referred to by the acronym “WITY.” This title is a reflection of body’s position during each exercise, which resembles one of each of these four letters when being performed. All four exercises are to be done while you lie flat with your stomach on the ground, either on the floor, a workout bench, or the edge of a bed, so that your arms can move freely. You can do these exercises with a light weight (1-2 lbs.) or with no weights, and you should aim to perform about 2-3 sets of 10-12 repetitions for each exercise:

• “W”
• Muscles targeted: rhomboids and middle trapezius
• How to perform: your arms will resemble a “W” at the start of this motion. For this exercise, raise your arms out so they are perpendicular with the spine; your elbows bent at 90 degrees, and your arms are rotated so your palms face down. Raise your arms and squeeze your shoulder blades together as far as you can while keeping your elbows bent.
• “I”
• Muscle targeted: Latissimus dorsi and mid-back muscles
• How to perform: your arms will resemble an “i” at the starting point of this motion with your elbows straight and at your sides to start. Your shoulder blades together as you lift your arms behind you towards the ceiling; your shoulder blades should guide your movement while keeping your arms close to your body,
• “T”
• Muscles targeted: posterior deltoids, rhomboids, and middle trapezius
• How to perform: hold your arms out to your side, making a 90-degree angle with your body, and have your palms facing the ground; squeeze your shoulders together as you raise your arms up as far as you can go, and then back down to the ground; your body will resemble a “T” for the entirety of this exercise
• “Y”
• Muscle targeted: lower trapezius
• How to perform: start with your arms above your head and slightly out to the side on an angle to create the shape of a “Y”; point your thumbs up and use your shoulder blades to lift your arms up to the ceiling as high as possible; there should not be much shrugging involved when performing this exercise

For additional guidance on how to properly perform the WITY exercises, click here or here (WITY exercises start around 3:32) to watch physical therapist-led instructional videos. These exercises should provide some relief for your myofascial pain, but if you’re still experiencing painful limitations, a physical therapist can also help by setting you up with a personalized treatment program to address your condition. We will discuss the role of physical therapy for myofascial pain syndrome in our next post.

In our last post, we explained that although it’s not completely clear what causes myofascial pain syndrome, several factors have been identified that likely contribute to its development. One risk factor that’s worthy of our attention is the use of poor posture while sitting. And since working from home has become part of the new normal for millions of Americans this past year, using proper posture at your desk is perhaps more important now than ever.

Posture is essentially the position your body is in at rest and during all movements, but we’re going to focus specifically on posture while sitting at a workstation since this is where many individuals spend the majority of their time. Research has shown that simply performing computer-based work for prolonged periods can lead to pain in the upper trapezius, levator scapulae, and rhomboid muscles, with longer durations of sitting associated with greater levels of pain. But sitting with poor posture at a desk that’s not set up properly can further compound this problem, as it forces you to overexert your body, which can cause you to strain your muscles and lead to other issues like myofascial pain syndrome.

The current thinking is that practicing incorrect body posture can cause the stabilizing muscles of the upper back and shoulders into a state of constant contraction. When these types of postures are held for much of the day, several days a week, it can lead to the development of trigger points and myofascial pain. This has been supported by several recent studies, which have identified a connection between workstation postures involving a mouse and keyboard and myofascial pain.

Prevent myofascial pain by optimizing your workstation ergonomics and correcting your posture

This underlines the importance of practicing good posture to reduce your risk for painful conditions like myofascial pain. Improving posture starts with optimizing the ergonomics of your workstation. Ergonomics is the science of fitting the job to the person through strategies that allow you to perform your job efficiently and with the least amount of strain possible. And according to Ryan Fogel, a Certified Ergonomic Evaluation Specialist, using good ergonomics and proper posture not only prevents painful conditions form occurring, but can also increase productivity by reducing mental and physical fatigue.

“The key to workstation ergonomics is keeping a neutral posture while avoiding reaching and repetitive motions,” Fogel says. “One of the more common issues I see when performing ergonomic assessments is the position of the keyboard in a workstation setup. Many people don’t position it correctly, which can cause a forward leaning trunk and improper positioning of the arms. Improper monitor placement is another big one that can be easily corrected.”

Reaching too much can throw off your posture, so you should try to have everything at your desk within arms’ reach, or the “easy reach zone” as Fogel calls it. “If you were to draw a 12×12 inch box about 6 inches form your body, that would be your ideal zone that everything should be placed in to avoid overreaching. Anything beyond your arms’ length can lead to excessive or repeated twisting of the body which can cause the neck and back muscles to overwork.”

According to Fogel, it’s possible to achieve a “neutral posture” by making some basic modifications to your desk setup. Starting from the ground up, here’s how you can improve your workstation ergonomics:

• Feet: keep them secure and flat on a surface, either the ground or a footrest
• Knees: should be equal to or slightly below the chair’s height
• Back: push your hips back as far as they can go, so your back is completely supported by the chair; this allows the chair to support your spine and makes it easier for you to sustain your posture
• Elbows and wrist: keep your elbows by your side and aligned with the keyboard to avoid overreaching, and keep your wrists straight in a neutral position, at about the same height as your elbows and supported by the armrest or desk
• Keyboard: ensure that it’s centered with your body to minimize rotation of the back; if you’re using a traditional keyboard with a 10-key keypad at the bottom right, disregard the keypad and instead center yourself using only the letter portion of the keyboard
• Monitor: if using a single monitor, center it with your body; if using dual monitors, push them together and align the center of the monitors with the center of your body; monitors should be about 18-30 inches from your body, and your eyes should be about two inches from the top of the screen
• Shoulders: keep them relaxed and in a neutral position
• Other: there is a wide array of other devices that can be used to improve the ergonomics of your workstation, such as document trays to reduce head and neck movements, electric staplers, electric hole punchers, ergonomically designed keyboards, and ergonomically designed mice, which may be semi-vertical or completely vertical

To picture a neutral posture, think about how you would sit at a dining room chair with your hands on your lap, Fogel says. This is what you want to aim for.

Focusing on your workstation ergonomics and practicing good posture is a smart move that can lead to a host of benefits, including a lower risk for myofascial pain syndrome. Unfortunately, these changes are no guarantee, and myofascial pain may still develop nonetheless. Our next post explores how targeted exercises can alleviate pain in these cases.

The spine is one of the biggest problem areas of the body. Pain occurs frequently from the lower back up through the upper spine, neck, and shoulders, often leading to some degree of impairment in the process. In the middle and upper regions of the spine, there are several issues that may be responsible for pain. A condition called myofascial pain syndrome is a common problem in these areas and the subject of this post.

Fascia is a thin, connective tissue that surrounds and connects every muscle in the body. The fasciae—plural of fascia—hold muscles together and allows them to stretch and contract against one another smoothly, without creating any friction that can damage the muscles. This explains the root word “fascia” in myofascial pain syndrome, whereas “myo” refers to muscles the muscles that these fasciae connect.

Myofascial pain involves triggers points, which are areas of tenderness and stiffness within muscles and fasciae that reduce range of motion. These trigger points are essentially muscle fibers that are stuck in contraction, which causes the muscle(s) to tighten and eventually prevents blood from flowing to the area. Trigger points feel like small bumps or knots when touched, and when enough of these occur in a certain area, the result is myofascial pain.

Below, we provide answers to some of the most commonly asked questions about myofascial pain syndrome to help you better understand what it is and how to identify it.

Q: How common is myofascial pain syndrome?

A: It is estimated that myofascial pain affects approximately 44 million Americans, and according to the Cleveland Clinic, about 85% of people will experience it at some point in their lifetime. Middle-aged women who are not physically active appear to have the highest risk for myofascial pain syndrome.

Q: What other terms are commonly used to describe this condition?

A: Myofascial pain syndrome is also referred to as simply myofascial pain, neck strain, upper trapezius pain, rhomboid strain, thoracic strain, or myofascial trigger points.

Q: What muscles are usually involved?

A: Myofascial pain syndrome can affect any muscle in the body, but it is most common in the muscles of the upper back, shoulders, and neck. Notable muscles in this region include the following:

• Trapezius: the trapezius is a large, broad muscle shaped like a triangle that extends from the base of the skull to the middle of the back; it helps give you the ability to tilt and turn your head and neck, shrug and stabilize your shoulders, and twist your arms; the upper trapezius is one of the most common sites for myofascial pain because it takes on a significant amount of pressure, especially when carrying items
• Levator scapulae: this is a long and slender pair of muscles shaped like straps that run from the top of the spine to the top edge of the shoulders; the main function of these muscles is assisting with the raising and rotating of your shoulder blade; they also stabilize this region
• Rhomboids: this is a pair of upper back muscles that run diagonally from the inside border of the shoulder blades and attach to the middle back vertebrae of the spine; the rhomboids attach the shoulder blades to the spine and help to rotate and/or pull the shoulder blades together during contraction

Q: What causes myofascial pain syndrome?

A: Experts are still not entirely sure why myofascial pain syndrome occurs, but it’s believed that injury or trauma to the spine—from physical activity or repetitive muscle strain—likely plays a role in its development. Other possible causes include consistently using poor posture, which can strain muscles, as well as lack of muscle activity or muscle weakness, stress, working in cold environment, and a pinched nerve.

Q: What does myofascial pain syndrome feel like?

A: Although symptoms vary from person to person, pain is usually described as a deep aching, a throbbing sensation, or tightness and stiffness, which occurs either at the trigger point or in a nearby area (referred pain). Patients will also report the presence of trigger points that cause pain when touched—and sometimes without being touched—tender or sore muscles, and/or weakness, which can lead to reduced range of motion in the upper spine, shoulders, or neck.

Read our next post to learn more about how you can reduce your chances for developing myofascial pain syndrome by improving your posture.