Welcome to the page for
Physical Therapists!

A tremendous amount of time and energy has been spent on researching back pain and still over 85 percent of the time the cause of back pain is unknown. What's missing? I believe we need to look at the activities that increase the patient's pain and then evaluate to see if the patient has the mechanics needed to perform those activities.

I believe we will find that many of the 85 percent do not have the mechanics required for the activities that increase their pain. These activities can include sitting, standing, walking and lying down. In most cases it is easy to see the impact of the patient's limitations on their back during those activities.

To identify the connection between the limitations, the back pain and the activities that increase the back pain, PT's need to take measurements of the patient's mechanics and compare that to a measurable description of the patient's pain and to the specific positions of the back that increase the pain. The System Limitations Evaluation is the result of putting together the steps for that process. You can find the evaluation outlined in the book, Rescue Your Back.

Although it is easy to see the impact of limitations on the back it is still best to be methodical and measurable in the evaluation and treatment because our bodies and lives are complex and that increases the chance of missing important connections. An abbreviated evaluation increases the chance of only finding and addressing the more obvious limitations while leaving limitations unidentified and untreated.

To facilitate being methodical and measurable the patient can use the questions in the book to help them describe their pain in measurable terms and the PT can use the PT Measurements DVD as a guide for the objective measurements. The DVD reviews the fundamental measurements to take, the recommended measurement technique and suggestions of patient education to provide while taking the measurements. Patient understanding of how their limitations impact their back is a cornerstone to the success of their program.

A couple of examples of connections between pain, positions of the back that increase pain and the measurement of mechanics are:

  • Patient has pain with sitting. Pain increases with lumbar flexion.
    Measurements reveal hip flexion of 70 degrees, when hip flexion range of motion is taken with the back maintained in the neutral position.
    In sitting, the back has to compensate by moving into lumbar flexion. I often say to patients, it is okay that your back flattens just not every time you sit.
  • Patient has pain with standing and walking, relieved with sitting. Pain increases with lumbar extension.
    Measurements reveal ankle dorsiflexion of -14 degrees and the calcaneal eversion of -10.
    In standing and walking both limitations cause the foot to pronate, the hip to internally rotate, the pelvis to tilt anteriorly and lumbar extension to increase.
    No matter how much we treat the back for hypomobility if we do not effectively improve dorsiflexion and calcaneal eversion the excess force placed on the back is going to continue when standing and walking.

In the present system it is difficult for many PT's to perform these measurements in the time allotted for an evaluation. That is why Rescue Your Back was written for the lay person. The book recommends that the patient actively work to find a PT who will take these measurements. The book also recommends that the patient talk to their insurance company about reimbursing the evaluation or having the patient offer to pay for the evaluation themselves.

Anticipating that patients will reach out to PT's the PT Measurements DVD was created to provide a means for the PT to know what measurements are recommended in this evaluation prior to meeting with the patient.

The PT Measurements DVD presents the following:

  • The measurements in the System Limitations Evaluation for Back Pain that are utilized to determine if limitations in the patient's mechanics are causing their back pain.
  • The technique for each measurement is presented (except for strength testing). The technique is presented in part to:
    • increase the probability that you are measuring what you intend measure. For example, that the measure of hip extension range of motion is hip extension and not hip extension with an increased anterior pelvic tilt and increased lumbar extension.
    • ensure that the back is positioned in neutral, prior to and throughout the measurements of range of motion, strength and motor control.
  • The importance of patient education when taking measurements. This is an ideal time to help the patient understand how the limitations you identify are related to the activities that increase their pain.

Future educational efforts will be based on need and interest, including seminars and DVD's. Back pain is a huge topic. There is a lot to do and there will always be more for us to learn. Over time this page will evolve; your input and contribution is most important.

PATIENTS SEEKING A PT: For those of you who are interested, this website will include the names of PT's for patients seeking a physical therapist offering this approach. If you offer this approach and want to have us list your name on this site, please let us know.

We welcome any input, questions or concerns. We have an e-mail address dedicated to physical therapists: pt@rescueyourback.com.

Thank You for your interest and we look forward to your feedback.

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