Episode 21 - Physical Therapy and Health Tips for Patients with Back Pains, With Eleanor McMillan, PT
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Episode Summary
Do you frequently suffer from back pain and don’t know the right way to treat them? Or do you think your home exercises are making the pain worse? Patients often mistake the difference between being physically active versus going to physical therapy to treat a specific injury, causing them to worsen the pain and fail to properly recover from herniated discs or muscular back strains.
In this episode of Back Talk Doc, our host Dr. Sanjiv Lakhia, welcomes Eleanor McMillan, PT, a physical therapist who loves to exercise and enjoy a healthy lifestyle; she’s also helped numerous patients recover from painful back injuries. Eleanor shares the virtues of physical therapy and how it can help you regain control of your life when suffering from back pain.
Eleanor stresses that physical therapy has a specific purpose, a particular strength, and a frequency to help people; all patients are different, and you may wonder, what makes my pain better? What makes it worse? “Are your hamstrings tight? Are your hips weak? What’s your core look like? Or are your hip flexors very tight because we’re sitting at an office desk all day? Those are the kinds of things that we…look at.” (12:17)
Primarily, she wants to give her patients their lives back when they feel there is nothing they can do, like activities around the house or even gardening. “It’s just…teaching them activity modification, getting them the right dosage of standing tolerance, activity tolerance, how we can kind of slowly manipulate those variables to help out the patient and kind of give them their life back because they feel like they can’t do anything!” (16:44)
Eleanor also tells us the steps to follow after recovering from disc or sciatic pain; how important it is to maintain your cardiovascular activity and the different exercises that can be done from home so as not to fall into the same physical pains again: ellipticals, swimming, static bicycles, etc.
For more information on patient education, visit our webpage backtalkdoc.com.
If you enjoyed this episode with Eleanor McMillan, PT, check out our episode on Spinal Stenosis with Joe Cheatle, MD.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Do you frequently suffer from back pain and don’t know the right way to treat them? Or do you think your home exercises are making the pain worse? Patients often mistake the difference between being physically active versus going to physical therapy to treat a specific injury, causing them to worsen the pain and fail to properly recover from herniated discs or muscular back strains.
In this episode of Back Talk Doc, our host Dr. Sanjiv Lakhia, welcomes Eleanor McMillan, PT, a physical therapist who loves to exercise and enjoy a healthy lifestyle; she’s also helped numerous patients recover from painful back injuries. Eleanor shares the virtues of physical therapy and how it can help you regain control of your life when suffering from back pain.
Eleanor stresses that physical therapy has a specific purpose, a particular strength, and a frequency to help people; all patients are different, and you may wonder, what makes my pain better? What makes it worse? “Are your hamstrings tight? Are your hips weak? What’s your core look like? Or are your hip flexors very tight because we’re sitting at an office desk all day? Those are the kinds of things that we…look at.” (12:17)
Primarily, she wants to give her patients their lives back when they feel there is nothing they can do, like activities around the house or even gardening. “It’s just…teaching them activity modification, getting them the right dosage of standing tolerance, activity tolerance, how we can kind of slowly manipulate those variables to help out the patient and kind of give them their life back because they feel like they can’t do anything!” (16:44)
Eleanor also tells us the steps to follow after recovering from disc or sciatic pain; how important it is to maintain your cardiovascular activity and the different exercises that can be done from home so as not to fall into the same physical pains again: ellipticals, swimming, static bicycles, etc.
For more information on patient education, visit our webpage backtalkdoc.com.
If you enjoyed this episode with Eleanor McMillan, PT, check out our episode on Spinal Stenosis with Joe Cheatle, MD.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years.
[00:00:21] And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
[00:00:35] Sanjiv Lakhia: Good morning, good afternoon, or good evening, whatever time of day you are listening. Thank you so much for downloading the episode and listening to this next episode of Back Talk Doc.
[00:00:46] Once again, I'm your host Sanjiv Lakhia and I'm an osteopathic physician, a DO board certified in physical medicine and rehabilitation, otherwise known as a physiatrist. And I have the privilege of working at what I believe to be the preeminent neurosurgical practice in the country. That is a Carolina Neurosurgery and Spine Associates.
[00:01:07] Our home base is in Charlotte, North Carolina, but we really have outreach throughout the Carolinas. And even beyond we've been able to cover so many excellent topics regarding the education of back pain and spine care. My mission is to empower you the listener with up-to-date information, accurate information and a broad variety of information that allow you to make better decisions when it comes to the care of your spine and your health.
[00:01:36] In general, today, we're going to be interviewing Eleanor McMillan. She's a physical therapist in our office in Rock Hill, South Carolina. And I have the pleasure of working with her on a day to day basis. In the past, I've been able to interview Ryan Klomparens regarding the role of the glute muscles in back pain and running.
[00:01:57] We've spoken with Jacob Beaman, one of our physical therapy assistants, and we really did a deep dive into CrossFit and more athletics as it pertains to back care. We've had a recent episode with Jay Murugavel, where we broke down thoracic outlet syndrome, along with Emily Tucker's input. But today with Eleanor, I really wanted to pick her brain and just help provide those that are listing a really good understanding about physical therapy and its role in the care of low back pain.
[00:02:27] Get a lot of pushback on physical therapy from the community, but those who actually see it through have amazing results. So Eleanor, welcome to the show.
[00:02:37] Eleanor McMillan: Ah, thanks so much for having me. I'm excited to do this.
[00:02:39] Sanjiv Lakhia: Okay. Let me introduce you to the people listening, Eleanor. Is a graduate from Wingate University where she obtained a doctorate in physical therapy.
[00:02:49] She did undergrad at Auburn University with a Bachelor's in Biomedical Sciences. She's been working with Carolina Neurosurgery and Spine Associates since 2018. She has specialty certification in dry needling through the American Academy of Manipulative Therapy. And Eleanor is one of the more passionate physical therapists that I've met.
[00:03:08] And some of this comes from her personal experience, multiple sport related injuries that she might talk about today. If he's helped her grandmother through various musculoskeletal injuries and really advocates for our patients exercise and the importance of just staying active. She also enjoys playing with her two dogs and with her fiance, and we all know she's an avid Auburn Tigers and Carolina Panthers fan.
[00:03:34] So Eleanor, why don't you briefly introduce yourself to those lists and give them a sense for kind of what your path was into the world of physical therapy and in spine care in particular?
[00:03:45] Sure, absolutely. I guess you want to really go all the way back my, uh, journey to physical therapy, funnily enough, started in kindergarten where I used to give my kindergarten teacher some massages.
[00:03:58] And she used to be like, Hey, yeah, I think it would be a great career for you. And it's kind of always stuck in my brain. Cause everyone always said, hey, don't find a job that you sit down too much and cause you are way too ADHD for that. So I've always kind of, tilted that direction. Healthcare has always been something I've been passionate about and just keeping people active and moving.
[00:04:22] So it was an easy transition. I actually started going into Auburn and a communications degree thinking I was going to go work for ESPN. And that didn't work very well because I switched my major pretty much immediately back to PT. And stay true to my roots and here I am, but I think the path that PT started growing up, because I played three sports, soccer, basketball, and tennis, and I transitioned through seeing multiple musculoskeletal injuries through those lenses and rehab women with ACL and broken bones myself.
[00:04:57] Thankfully enough, I've knocked on wood, stayed away from an ACL tear through my three sports, but, sports have always been my kind of crutch and motivation towards physical therapy. But then on the other end of the spectrum, I've always had my grandmother who we were always really close to and she had, let's just put it as multiple health conditions.
[00:05:21] So I was always taking her to different appointments and that sparked more of the, you know, keep people active, keep them up and moving because she was always very, defiant about sitting still. And so she wanted to keep up her active lifestyle. So we were always trying to take her to the physical therapist to get her up and moving and keep her doing her exercises at home.
[00:05:43] So I think I found that kind of passion through her and through the physical therapist that she got therapy with.
[00:05:51] Well, I think we've said before on this show that. A lot of people have a personal experience that can propel them into a professional career. It sounds like that's kind of where your passion was born.
[00:06:03] Let's dive into a little bit about today's topic, which really involves discussing the benefits of physical therapy for low back pain and what patients can expect when they come to see you or really any physical therapist within our group to address our condition.
[00:06:20] Now, you know, I talk with patients a lot. I get a lot of pushback in terms of, is it worth the copays? Is it worth the time commitment? Why do I need to do this? I'm active. Can you explain just a little bit the difference between someone being active versus going to physical therapy to treat a specific injury?
[00:06:41] Eleanor McMillan: Yeah, absolutely. That's definitely something that we fight with all the time and... it's a great question. It happens, you get it, I'm sure we get it. We get it multiple times. Not just once. The biggest differences everybody says they're active. I get people that say they're active and they walk back and forth from their chair to their fridge multiple times a day, or, "oh, I'm constantly up doing chores and doing different types of, you know, household activities, gardening" whatever that their activity level says.
[00:07:17] And yes, that's great. But when you have low back pain, when you have neck pain, when we're kind of dealing with something that's out of your ordinary, daily activity level with the pain, going to PT and kind of honing in and looking at where our muscles, where we're inhibited, where we're tight, where, you know, our flexibility is weak, that's where I think the difference is your day to day activity level, something has changed. You know, we're missing a key ingredient to your makeup at that point and something has, you know, in your back has changed, but also let's take a look at what's has changed muscularly, and that is a big difference with what we go to in PT.
[00:08:00] And I think that's where the key component is lost in translation. Most people say, "oh, I'm active, but what's PT going to do" well, we're going to look at, okay, like you have previously with Ryan, are your glutes working? What can we do to change up that activity level to kind of add in that extra ingredient to make you get back to that previous activity level or now even better because we've kind of diagnosed what you're missing.
[00:08:26] Sanjiv Lakhia: Yeah, exactly. And what I like to tell people is that physical therapy think of it in the same light you would a prescription medication, so to speak. It has a very specific purpose, a specific strength and frequency. That you want to be involved with it. So it's in my mind, it's, it's no different than, than that.
[00:08:46] But for most patients, it's very customized approach where you can identify what has gone wrong from a structural basis, and then utilize customized exercise prescription to deliver a better outcome. And then when we put it in that light, I think it makes sense not to mention there's a lot of research, a lot of research supporting the benefits of physical therapy for low back pain.
[00:09:11] Now, if someone comes to see you, can you give them a general sense of, let's just take a few cases in mind. So I want to look at maybe first, someone who has low back pain with some sciatic symptoms and then, maybe compare to someone who has back pain that doesn't involve the leg symptoms. And then lastly, I want to kind of get your expertise on your approach to lumbar stenosis.
[00:09:35] We've done a full episode interview from the surgical perspective with Dr. Joe Cheadle. And if you haven't heard his episode is excellent. And one of our more popular ones, so feel free to download that, but I'll let you start. Let's start with, okay. I'm coming to see you. My back hurts. I just moved some furniture. It's kind of shooting down my leg. This happened about two weeks ago. And I've been sent to see you Eleanor, take me through your mental workflow about how you assess the condition and maybe put together a plan.
[00:10:06] Eleanor McMillan: Yeah. So, you know, I always tell my patients come in and I wanna, you know, get a good background.
[00:10:11] What's been going on. So it's been two to three weeks. You still having the leg pain, we got to rule out anything else, and then it's going to be more so what kind of activity levels aggravate it? What can we do? Can we, I don't ever want to tell my patients let's not do something cause that's, I don't think that's a very positive way to go into physical therapy, right?
[00:10:32] No one likes being told, "hey, this is not what you should do", like that sounds terrible. And you're not going to gain any trust. So I think the first thing you do is we find how someone goes about their day. You find, kind of things that you can tweak. Is it okay? You get leg pain when you stoop over to unload the dishwasher. Okay, well can we put a chair down in front of the dishwasher and then put the plates on top of the countertop and then stand up from the countertop up and put the plates up. Can we do it that way? Or, you know, can we get a grabber to help you get something out of the dryer? Cause that's where your, that leg pain that radicular pain comes out.
[00:11:12] How can we kind of twist your day up or tweak your day? To help out that pain. I think that's the first place to always start. And then it's alright well, are you getting up and moving? Are we doing things to promote healthy lifestyle? Promote that those muscles trying to work those nerves, sending out the right message static sitting throughout the day is not going to help us recover, it's not going to help you feel better. So how can we promote that first that's before we even start any exercise, any real kind of, you know, hands-on diagnosis of exercise or you know, how your body is presenting and then it's okay. We know we have these particular symptoms, what makes it better? What makes it worse? We've talked through what makes it worse? What makes it better? How do we kind of approach that? How can we, you know, say, "oh, just take a break. If it bothers you ever 20 minutes, but sitting helps let's sit". And then we've kind of discussed that.
[00:12:15] So now we're going to go into kind of, okay, are your hamstrings tight? Are your hips weak? What's your core look like? Or are hip flexors very tight because we're sitting at an office desk all day? Those are the kinds of things that we kind of look at. And then we said, okay, well, we can kind of work with that. And let's usually your hamstrings are always tight, you know, but that's not always the problem is it, you know, now we kind of sit all day in a chair, that's bad for us ergonomically.
[00:12:44] And we have more of an anterior tilt of the pelvis. What can we look at that? So kind of giving people an idea of where or weaknesses are or where our strengths are, but then we don't have that equal counterpart to help us out with those muscular, from the front. Of the body versus the back of the body.
[00:13:01] I think that's usually where we start and then kind of progress as to where some of the weaknesses are. And then a lot of low back pain. We do have hamstring tightness. We do have hip external rotator, a weakness, hip abductor, weakness, glute weakness, core weakness, and that's I think where we start and then that radicular symptom usually tends to find its way, getting better as we kind of take care of those situations that increase the pain at the home.
[00:13:33] Sanjiv Lakhia: Let's kind of deconstruct that cause we went through a lot. I think a good way to describe this as if you're going to PT, first thing you're going to do is take a really good detailed history, really understand what are the things that are aggravating or helping the pain so you can understand what, what makes it feel better? What makes it feel worse? And based upon that, then you can make some initial activity modification recommendations, and that's always something I try and recommend. And folks activity modifications are very, very important.
[00:14:05] If you struggle with any spine condition, I mean, they can be almost as important as any medication, any shot or any other intervention, something as simple as getting a footstool to put your leg on, when you're working at the counter, doing your dishes or sitting at your desk or having a standing desk, these little things make a major, major difference.
[00:14:23] And the, once you go from that, then you start looking at the mechanical assessment where you're looking at a patient's overall physical status, what's tight, what's weak. So then based upon that, you can design a customized exercise program. And what she said, there is very important. Even in the midst of pain, if you can establish some degrees of pain-free mobility, even if it doesn't look the way it did before you hurt yourself, if you can get the body going back to some type of motion, that is how you start to turn the dial down on the nervous system and the pain response.
[00:14:59] And that that is so important. It goes against the age old wisdom of if you hurt your back, you need to lay in bed for six weeks and traction, which used to be the standard of care. No longer is that the case? In fact, for almost everything in the orthopedic and spine world early mobilization is the key to a cooker recovery.
[00:15:16] We didn't touch on this before, but there's a program called the McKenzie Program, which looks at positioning the body. So alleviate pain, going down your leg, depending on the type of thing, disc herniation, you may or may not have. And that's kind of what you were touching on before about asking the patient if it's better or worse when they're bending over. Is that not so?
[00:15:36] Eleanor McMillan: Definitely. Yes. The McKenzie Method definitely is there to kind of decrease pain and what we call centralization or the nerve pain, moving more towards the center of your body. And that's usually a sign of healing or, you know, feeling better.
[00:15:51] Sanjiv Lakhia: Yes. Yeah. So that's where the history comes into play.
[00:15:55] Give me your thoughts, Eleanor, on spinal stenosis. And just for those who haven't heard, the previous episode spinal stenosis is typically a degenerative, somewhat of an age related condition where you over the course of time, develop a narrowing effect within the spinal canal. As a result of arthritic changes as a result of disk wear and tear, and that narrowing effect within the spinal canal can slowly compress the nerves that go down into your legs and create a clinical syndrome of back pain with leg symptoms, such as heaviness, numbness, fatigue and pain, particularly with standing and walking. And so it's a little bit of a different clinical entity than let's say just a traditional herniated disc or muscular back strain. What has kind of been your experience with physical therapy interventions for spinal stenosis?
[00:16:44] Eleanor McMillan: We get a ton of spinal stenosis patients and we have really good outcomes with them for the most part. But once you gain, like you said earlier, the biggest key is what we say "the motion is lotion", the more we can get into with that activity improvement, even that slight change in motion ability and moving around the better off we are, you know, we can get someone walking 60 feet and, you know, two weeks later they're walking 120 feet.
[00:17:15] It's just, you know, kind of teaching them activity modification, teaching them, getting them the right dosage of standing tolerance, activity, tolerance, how we can kind of slowly manipulate those variables to help out the patient and kind of give them their life back, because they feel like they can't do anything.
[00:17:36] The ability to kind of do activities with spinal stenosis, they feel like they can't do much, right? As soon as they stand for five, 10 minutes, they're feeling that heaviness, they're feeling that aching in their legs. And we want to kind of get rid of that and allow them to have their lifestyle back.
[00:17:55] But it's almost the same thing with it. It's how can we moderate activity level according to the patient and see what kind of freedom we can give them.
[00:18:06] Sanjiv Lakhia: Now at our group, I've really noticed the physical therapy approach is slightly different in that we lean on lot, a little more on exercise, prescription and exercise rehab.
[00:18:16] Then we do modalities technologies and toys. Having said that, I know there's a lot of questions out there, they're from the general population about, some of these interventions, let me just kind of toss them out and get your thoughts, opinions on them. One is dry needling, and I did a kind of a compare and contrast episode of dry needling versus acupuncture recently, so if you haven't heard that, feel free to take a listen. I want to get your thoughts on dry needling, electrical stimulation, and then some other, there's the TRX system that is more of an exercise system. Well, we even spoke recently together about the gravity assisted treadmill. So just give me your general mindset about modalities and their place in rehabilitating back injuries.
[00:19:04] And then if you have any specific comments or opinions about the ones I just mentioned, I'd love to hear those as well.
[00:19:10] Eleanor McMillan: Oh gosh. I would love an officer G in our clinic, but yes, modalities have come in many different packages now and I feel like. The physical therapy world is everything is the new rage, you know, and the Olympics that was the cupping and everybody then wanted cupping.
[00:19:28] And then now it's dry needling or myofascial release. Those are kind of the, you know, all the rage terms, but you're right. I think we do try to focus here at our clinic, much more about exercise dosing and prescription, but that doesn't mean that those things don't have their place. Because I will absolutely dry needle someone who I think is appropriate or use Estim, or I love the TRX system we have in our office. I think all of those modalities absolutely depend on getting the patient to their goal, right? So if we can get or help skip a couple of steps with dry needling or Estim, to get to their functional goal, then I think that that is going to help the patient. But what I don't want to do is make a patient reliant on my services or my care with the modality to where they need to come back in, or they feel like they need to come back in every two weeks and not be independent in their own care. Right? So my goal is to get them out of our office. I don't want to see them back, so I don't want to make them reliant.
[00:20:41] Sanjiv Lakhia: I love that. That is exactly. I think why the therapy program here is so effective. One of the reasons that our group in particular focuses on the exercise component is that's where the evidence and the research really is supportive for longterm benefits and sustained benefits with PT interventions.
[00:21:03] I definitely liked the idea of saying that the modalities are tools in the tool box, but the ultimate goal is functional improvement. And if we're doing our job well, patients should need us less or not at all. And that's really the model that I think is a modern day model is what people need. People don't have the time, the money, the energy to come for two, three, four, dozen visits.
[00:21:26] So what we really believe in what I believe personally is if we can teach you how to take care of your back, put you on the right path with proper exercise prescription. And generally you'll do well. And then you can check back in periodically, if you need some dry needling or you need some treatment.
[00:21:40] And as, just as a side note, for those who aren't aware of the TRX system, it's a kind of a cable system. How would you describe that for someone who doesn't know what that is?
[00:21:50] Eleanor McMillan: Probably like suspended straps that you can hook your feet into and also have handles to grab onto. So it's a great body weight assisted training tool to kind of work through multiple different things. You can work upper body, lower body, core all with the straps, that kind of hook in, depending on how you have your setup at home. It is a home set up to where you can do it, like over a door, hooked up through drywall different kinds of connections at home so that you can kind of take the suspension system anywhere with you.
[00:22:28] Sanjiv Lakhia: And then the alter G is a gravity assisted treadmill that has probably more applications in the orthopedic world to allow individuals to walk or run without significant weight bearing effect on a joint. Is that, is that a good description?
[00:22:44] Eleanor McMillan: Yeah, absolutely. They definitely can put you in that zero gravity environment where you can just take all the stress out of kind of rehab, but definitely much more implications for orthopedic injuries and recovery for that.
[00:23:00] Sanjiv Lakhia: I think for spine care, probably a better alternative to that, more practical alternative would just be having people do some movement in a pool because we do know that the water has compressive effects, which help with lymph flow and edema. And it also takes away about half your body weight when you're in the pool. And I've had a lot of patients who've had low back injuries really begin to recover through using exercise in the water.
[00:23:26] Eleanor McMillan: I love that.
[00:23:27] Sanjiv Lakhia: Now we've covered some really good specifics about PT approach for back pain. One of the questions I get a lot is, well, what should I be doing after PT? Like I've gotten better. I no longer have that disc pain or sciatic pain. I want to get back to my general physical fitness goals, like keeping my weight down, cardiovascular fitness up, strength up. And I get asked, what's a safe form of exercise for someone who has had previous back injury. So kind of give me your thoughts on what you recommend to patients as maybe we look at how to approach from the cardiovascular perspective, and then maybe what you think is a safe way to approach maintaining your strengths.
[00:24:10] Eleanor McMillan: Yeah, we get that question a lot. Obviously, I think walking and aquatic therapy or exercise is a great option just to keep the cardiovascular part up. But if you are a previous runner and now you were getting sciatic pain and you want to get back to running, we have a return to running program where it's a much slower advance, back to jogging, and we'll probably do it at much less.
[00:24:37] Frequency to start with trying to keep that, you know, make sure all the work that we've done, all the homework that you've done, you know, stays put and all those glutes hamstrings, all the muscles that we've kind of worked on are staying strong. The biggest key is continuing your home exercises program, but it doesn't have to be every single exercise we give you.
[00:25:01] We give you a huge toolbox by the time you leave here. And so that means maybe I pick a core exercise, a lower extremity exercise, a front of the body leg exercise or back, or the body leg exercise do about four or five of them a day and then alternate or switch it up. It doesn't have to be every day. It doesn't have to be all of them, but we want to get you to the point to where you can do something consistently.
[00:25:30] So, you know, the exercises that really help you and help you with your goals. So we want to keep those up and then it's, you know, I always, my friend coined this phrase "old, not weak" for some of our patients. Now, it's okay, you've done all this work and you want to get back to it, well, I hope when you've left, you almost feel like you're better than you were before.
[00:25:54] So now you can go do your gardening, your household chores. Anything. If you are a golfer, if you, I had a patient in here earlier, it was played disc golf. If you want to go back and do those things, you're now doing them better than you were before, because we're activating the correct muscles and you're keeping up with that program.
[00:26:15] Sanjiv Lakhia: Yeah, that's really good. When the gyms open up, hopefully sometime soon in the midst of this pandemic, people are going to be looking at a lot of options. There's elliptical machines, stationary bikes, recumbent bikes, rowing machines, just to name a few. And I'll kind of give you my take on them. And you tell me if you agree or disagree.
[00:26:35] I think that for most people, the elliptical machine is probably the best tolerated least risk. If you have, let's say history of a bulging disc and low back pain, I think stationary cycling can be done well, but if you're sitting and leaning too far forward for half an hour to an hour, it can trigger some disc pain.
[00:26:54] I've advised people that the rowing machine, which I think is a wonderful all-in-one exercise for cardiovascular and strength and aerobic and anaerobic exercise is fantastic if you do it right. And if you're slightly off in your form, it's a disaster, way too much needed chest fluxion and compressive llection movement on the disc itself, almost squeezing the disc.
[00:27:19] You know, so those are just my general thoughts. I think the recumbent bike, might be a little better version for biking where you can have, have better posture, maintain a neutral spine wall while you're on it. What do you think about those thoughts with those exercise equipment?
[00:27:32] Eleanor McMillan: Yes, I completely agree with you.
[00:27:34] The only thing that I would change is I don't like the ellipticals and I think they're phasing more of them out, but I don't like the ellipticals that have the very large arms swings with the handlebars, just because that puts too much twisting on the low back. And that compressive force gets a little bit, can be a little bit too much.
[00:27:58] So that's one of the few things. So I instead use no hands. If you have to, if your balance is good, that's going to really charge up that core and fire it up or use the stationary handles for if you need to hold on. And I love that forward and backward on the ellipticals. Great. I love the rower. I'm a personal user of it, but even there, I have to be super perfect with my form.
[00:28:22] So I definitely agree with you. If you have low back pain and you are not paying attention to your core and your hips and your back and your chest, you are more than likely when you get fatigued, going to cause some damage to that low back. So I usually tell most patients to probably stay away from it or if they really love it, and it's something that they have at home, go to really moderate resistance so that you're not going to put that much force through that low back and staying very upright. As well, their accumbent bike, I love it. There's nothing really that I would say, except that it doesn't hit a lot of that posterior chain or the backside of your body, enough that to come back, how much we sit throughout the day.
[00:29:07] As for the stationary bike, I agree with you. I think sitting on that seat can get very compressive and you'd have to tinker with it a lot to get the handlebars up to the correct spot.
[00:29:18] Sanjiv Lakhia: Outside of a fair number of patients who love swimming, what's your thoughts on mechanical effects of swimming and some of the different strokes on the low back?
[00:29:28] Eleanor McMillan: I'm okay with swimming. I think, you know, to the extent that you're going to do distance, I think the distance bothers you a lot more than sometimes the stroke that you select freestyle can put more pressure on that low back. Obviously, I don't really think butterfly should be in your game plan with some low back pain.
[00:29:48] I like breaststroke a lot and backstroke. I think those all can kind of in their own right. Be very efficient. Cardiovascular and muscle fatigue activities, but I think it's all done in your correct dosage.
[00:30:04] Sanjiv Lakhia: That's fantastic. I think you've really given some high yield information for people who are going to listen to this and given them some directions.
[00:30:11] So I really appreciate your insights today. I want to kind of just wrap up. I always wrap up my interviews by picking the brains of the people I'm talking to about their health routines. I think health and wellness is such an important topic in this country today. And there's, my belief is there's no one right way, but I know you're very health conscious.
[00:30:30] Do you have any strategies or tips that you want to share with people?
[00:30:34] Eleanor McMillan: For the most part, I try to run or get in some kind of cardiovascular activity two or three times a week. And then I think as a woman, I try to lift heavy. Now heavy is according to what I can lift. I'm not saying go out and lift 200 pounds daily, but I do try to lift heavier twice a week to help out and combat the bone density.
[00:31:02] The benefits of strength training. I do try to lift a little heavier and I think that's had tremendous effect on my strengths, my stamina and staying healthy. And I think I would always promote women lifting a little bit heavier than they can think a couple of times a week, because that's just shown to help out your entire system.
[00:31:23] As we're eating, I am on my own health journey and trying to do better with fruits and vegetables and eating, just trying to do better with my fruits and vegetables.
[00:31:37] Sanjiv Lakhia: Well, look, you're not alone. Everyone's on their health journey with food in particular. So if you have an awareness about it, you're ahead of the game, in my opinion. Do you have any great apps you like to use favorite books or other tools as a last kind of parting gift to the listeners?
[00:31:54] Eleanor McMillan: Oh, that's a good question. I was thinking about it earlier. I've not been on any apps or anything like that. Recently books, I have taken a hiatus from kind of cell phone usage and trying to get away from the dependency of my phone and social media.
[00:32:15] So, I've not been on it and I failed you there.
[00:32:19] Sanjiv Lakhia: Actually, that might be the best advice anyone has given an answer to that question. I think detoxing doing a digital detox is a very healthy thing, Eleanor. So don't change that at all. But listen, I really, really enjoyed the interview today and you throw out a lot of good stuff for people to consider and really thank you for your time today.
[00:32:39] Eleanor McMillan: Thank you for having me.
[00:32:41] Sanjiv Lakhia: And once again, thanks for listening. This has been a real pleasure to put together this information for the podcast. Again, if you'd like to learn more, feel free to check us out at cnsa.com. Also, if you haven't had a chance to take a look at the patient education book I put together, you can find that at backtalkdoc.com. Until the next episode, please take care of yourself and each other.
[00:33:06] Outro: Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health. On the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
[00:00:21] And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
[00:00:35] Sanjiv Lakhia: Good morning, good afternoon, or good evening, whatever time of day you are listening. Thank you so much for downloading the episode and listening to this next episode of Back Talk Doc.
[00:00:46] Once again, I'm your host Sanjiv Lakhia and I'm an osteopathic physician, a DO board certified in physical medicine and rehabilitation, otherwise known as a physiatrist. And I have the privilege of working at what I believe to be the preeminent neurosurgical practice in the country. That is a Carolina Neurosurgery and Spine Associates.
[00:01:07] Our home base is in Charlotte, North Carolina, but we really have outreach throughout the Carolinas. And even beyond we've been able to cover so many excellent topics regarding the education of back pain and spine care. My mission is to empower you the listener with up-to-date information, accurate information and a broad variety of information that allow you to make better decisions when it comes to the care of your spine and your health.
[00:01:36] In general, today, we're going to be interviewing Eleanor McMillan. She's a physical therapist in our office in Rock Hill, South Carolina. And I have the pleasure of working with her on a day to day basis. In the past, I've been able to interview Ryan Klomparens regarding the role of the glute muscles in back pain and running.
[00:01:57] We've spoken with Jacob Beaman, one of our physical therapy assistants, and we really did a deep dive into CrossFit and more athletics as it pertains to back care. We've had a recent episode with Jay Murugavel, where we broke down thoracic outlet syndrome, along with Emily Tucker's input. But today with Eleanor, I really wanted to pick her brain and just help provide those that are listing a really good understanding about physical therapy and its role in the care of low back pain.
[00:02:27] Get a lot of pushback on physical therapy from the community, but those who actually see it through have amazing results. So Eleanor, welcome to the show.
[00:02:37] Eleanor McMillan: Ah, thanks so much for having me. I'm excited to do this.
[00:02:39] Sanjiv Lakhia: Okay. Let me introduce you to the people listening, Eleanor. Is a graduate from Wingate University where she obtained a doctorate in physical therapy.
[00:02:49] She did undergrad at Auburn University with a Bachelor's in Biomedical Sciences. She's been working with Carolina Neurosurgery and Spine Associates since 2018. She has specialty certification in dry needling through the American Academy of Manipulative Therapy. And Eleanor is one of the more passionate physical therapists that I've met.
[00:03:08] And some of this comes from her personal experience, multiple sport related injuries that she might talk about today. If he's helped her grandmother through various musculoskeletal injuries and really advocates for our patients exercise and the importance of just staying active. She also enjoys playing with her two dogs and with her fiance, and we all know she's an avid Auburn Tigers and Carolina Panthers fan.
[00:03:34] So Eleanor, why don't you briefly introduce yourself to those lists and give them a sense for kind of what your path was into the world of physical therapy and in spine care in particular?
[00:03:45] Sure, absolutely. I guess you want to really go all the way back my, uh, journey to physical therapy, funnily enough, started in kindergarten where I used to give my kindergarten teacher some massages.
[00:03:58] And she used to be like, Hey, yeah, I think it would be a great career for you. And it's kind of always stuck in my brain. Cause everyone always said, hey, don't find a job that you sit down too much and cause you are way too ADHD for that. So I've always kind of, tilted that direction. Healthcare has always been something I've been passionate about and just keeping people active and moving.
[00:04:22] So it was an easy transition. I actually started going into Auburn and a communications degree thinking I was going to go work for ESPN. And that didn't work very well because I switched my major pretty much immediately back to PT. And stay true to my roots and here I am, but I think the path that PT started growing up, because I played three sports, soccer, basketball, and tennis, and I transitioned through seeing multiple musculoskeletal injuries through those lenses and rehab women with ACL and broken bones myself.
[00:04:57] Thankfully enough, I've knocked on wood, stayed away from an ACL tear through my three sports, but, sports have always been my kind of crutch and motivation towards physical therapy. But then on the other end of the spectrum, I've always had my grandmother who we were always really close to and she had, let's just put it as multiple health conditions.
[00:05:21] So I was always taking her to different appointments and that sparked more of the, you know, keep people active, keep them up and moving because she was always very, defiant about sitting still. And so she wanted to keep up her active lifestyle. So we were always trying to take her to the physical therapist to get her up and moving and keep her doing her exercises at home.
[00:05:43] So I think I found that kind of passion through her and through the physical therapist that she got therapy with.
[00:05:51] Well, I think we've said before on this show that. A lot of people have a personal experience that can propel them into a professional career. It sounds like that's kind of where your passion was born.
[00:06:03] Let's dive into a little bit about today's topic, which really involves discussing the benefits of physical therapy for low back pain and what patients can expect when they come to see you or really any physical therapist within our group to address our condition.
[00:06:20] Now, you know, I talk with patients a lot. I get a lot of pushback in terms of, is it worth the copays? Is it worth the time commitment? Why do I need to do this? I'm active. Can you explain just a little bit the difference between someone being active versus going to physical therapy to treat a specific injury?
[00:06:41] Eleanor McMillan: Yeah, absolutely. That's definitely something that we fight with all the time and... it's a great question. It happens, you get it, I'm sure we get it. We get it multiple times. Not just once. The biggest differences everybody says they're active. I get people that say they're active and they walk back and forth from their chair to their fridge multiple times a day, or, "oh, I'm constantly up doing chores and doing different types of, you know, household activities, gardening" whatever that their activity level says.
[00:07:17] And yes, that's great. But when you have low back pain, when you have neck pain, when we're kind of dealing with something that's out of your ordinary, daily activity level with the pain, going to PT and kind of honing in and looking at where our muscles, where we're inhibited, where we're tight, where, you know, our flexibility is weak, that's where I think the difference is your day to day activity level, something has changed. You know, we're missing a key ingredient to your makeup at that point and something has, you know, in your back has changed, but also let's take a look at what's has changed muscularly, and that is a big difference with what we go to in PT.
[00:08:00] And I think that's where the key component is lost in translation. Most people say, "oh, I'm active, but what's PT going to do" well, we're going to look at, okay, like you have previously with Ryan, are your glutes working? What can we do to change up that activity level to kind of add in that extra ingredient to make you get back to that previous activity level or now even better because we've kind of diagnosed what you're missing.
[00:08:26] Sanjiv Lakhia: Yeah, exactly. And what I like to tell people is that physical therapy think of it in the same light you would a prescription medication, so to speak. It has a very specific purpose, a specific strength and frequency. That you want to be involved with it. So it's in my mind, it's, it's no different than, than that.
[00:08:46] But for most patients, it's very customized approach where you can identify what has gone wrong from a structural basis, and then utilize customized exercise prescription to deliver a better outcome. And then when we put it in that light, I think it makes sense not to mention there's a lot of research, a lot of research supporting the benefits of physical therapy for low back pain.
[00:09:11] Now, if someone comes to see you, can you give them a general sense of, let's just take a few cases in mind. So I want to look at maybe first, someone who has low back pain with some sciatic symptoms and then, maybe compare to someone who has back pain that doesn't involve the leg symptoms. And then lastly, I want to kind of get your expertise on your approach to lumbar stenosis.
[00:09:35] We've done a full episode interview from the surgical perspective with Dr. Joe Cheadle. And if you haven't heard his episode is excellent. And one of our more popular ones, so feel free to download that, but I'll let you start. Let's start with, okay. I'm coming to see you. My back hurts. I just moved some furniture. It's kind of shooting down my leg. This happened about two weeks ago. And I've been sent to see you Eleanor, take me through your mental workflow about how you assess the condition and maybe put together a plan.
[00:10:06] Eleanor McMillan: Yeah. So, you know, I always tell my patients come in and I wanna, you know, get a good background.
[00:10:11] What's been going on. So it's been two to three weeks. You still having the leg pain, we got to rule out anything else, and then it's going to be more so what kind of activity levels aggravate it? What can we do? Can we, I don't ever want to tell my patients let's not do something cause that's, I don't think that's a very positive way to go into physical therapy, right?
[00:10:32] No one likes being told, "hey, this is not what you should do", like that sounds terrible. And you're not going to gain any trust. So I think the first thing you do is we find how someone goes about their day. You find, kind of things that you can tweak. Is it okay? You get leg pain when you stoop over to unload the dishwasher. Okay, well can we put a chair down in front of the dishwasher and then put the plates on top of the countertop and then stand up from the countertop up and put the plates up. Can we do it that way? Or, you know, can we get a grabber to help you get something out of the dryer? Cause that's where your, that leg pain that radicular pain comes out.
[00:11:12] How can we kind of twist your day up or tweak your day? To help out that pain. I think that's the first place to always start. And then it's alright well, are you getting up and moving? Are we doing things to promote healthy lifestyle? Promote that those muscles trying to work those nerves, sending out the right message static sitting throughout the day is not going to help us recover, it's not going to help you feel better. So how can we promote that first that's before we even start any exercise, any real kind of, you know, hands-on diagnosis of exercise or you know, how your body is presenting and then it's okay. We know we have these particular symptoms, what makes it better? What makes it worse? We've talked through what makes it worse? What makes it better? How do we kind of approach that? How can we, you know, say, "oh, just take a break. If it bothers you ever 20 minutes, but sitting helps let's sit". And then we've kind of discussed that.
[00:12:15] So now we're going to go into kind of, okay, are your hamstrings tight? Are your hips weak? What's your core look like? Or are hip flexors very tight because we're sitting at an office desk all day? Those are the kinds of things that we kind of look at. And then we said, okay, well, we can kind of work with that. And let's usually your hamstrings are always tight, you know, but that's not always the problem is it, you know, now we kind of sit all day in a chair, that's bad for us ergonomically.
[00:12:44] And we have more of an anterior tilt of the pelvis. What can we look at that? So kind of giving people an idea of where or weaknesses are or where our strengths are, but then we don't have that equal counterpart to help us out with those muscular, from the front. Of the body versus the back of the body.
[00:13:01] I think that's usually where we start and then kind of progress as to where some of the weaknesses are. And then a lot of low back pain. We do have hamstring tightness. We do have hip external rotator, a weakness, hip abductor, weakness, glute weakness, core weakness, and that's I think where we start and then that radicular symptom usually tends to find its way, getting better as we kind of take care of those situations that increase the pain at the home.
[00:13:33] Sanjiv Lakhia: Let's kind of deconstruct that cause we went through a lot. I think a good way to describe this as if you're going to PT, first thing you're going to do is take a really good detailed history, really understand what are the things that are aggravating or helping the pain so you can understand what, what makes it feel better? What makes it feel worse? And based upon that, then you can make some initial activity modification recommendations, and that's always something I try and recommend. And folks activity modifications are very, very important.
[00:14:05] If you struggle with any spine condition, I mean, they can be almost as important as any medication, any shot or any other intervention, something as simple as getting a footstool to put your leg on, when you're working at the counter, doing your dishes or sitting at your desk or having a standing desk, these little things make a major, major difference.
[00:14:23] And the, once you go from that, then you start looking at the mechanical assessment where you're looking at a patient's overall physical status, what's tight, what's weak. So then based upon that, you can design a customized exercise program. And what she said, there is very important. Even in the midst of pain, if you can establish some degrees of pain-free mobility, even if it doesn't look the way it did before you hurt yourself, if you can get the body going back to some type of motion, that is how you start to turn the dial down on the nervous system and the pain response.
[00:14:59] And that that is so important. It goes against the age old wisdom of if you hurt your back, you need to lay in bed for six weeks and traction, which used to be the standard of care. No longer is that the case? In fact, for almost everything in the orthopedic and spine world early mobilization is the key to a cooker recovery.
[00:15:16] We didn't touch on this before, but there's a program called the McKenzie Program, which looks at positioning the body. So alleviate pain, going down your leg, depending on the type of thing, disc herniation, you may or may not have. And that's kind of what you were touching on before about asking the patient if it's better or worse when they're bending over. Is that not so?
[00:15:36] Eleanor McMillan: Definitely. Yes. The McKenzie Method definitely is there to kind of decrease pain and what we call centralization or the nerve pain, moving more towards the center of your body. And that's usually a sign of healing or, you know, feeling better.
[00:15:51] Sanjiv Lakhia: Yes. Yeah. So that's where the history comes into play.
[00:15:55] Give me your thoughts, Eleanor, on spinal stenosis. And just for those who haven't heard, the previous episode spinal stenosis is typically a degenerative, somewhat of an age related condition where you over the course of time, develop a narrowing effect within the spinal canal. As a result of arthritic changes as a result of disk wear and tear, and that narrowing effect within the spinal canal can slowly compress the nerves that go down into your legs and create a clinical syndrome of back pain with leg symptoms, such as heaviness, numbness, fatigue and pain, particularly with standing and walking. And so it's a little bit of a different clinical entity than let's say just a traditional herniated disc or muscular back strain. What has kind of been your experience with physical therapy interventions for spinal stenosis?
[00:16:44] Eleanor McMillan: We get a ton of spinal stenosis patients and we have really good outcomes with them for the most part. But once you gain, like you said earlier, the biggest key is what we say "the motion is lotion", the more we can get into with that activity improvement, even that slight change in motion ability and moving around the better off we are, you know, we can get someone walking 60 feet and, you know, two weeks later they're walking 120 feet.
[00:17:15] It's just, you know, kind of teaching them activity modification, teaching them, getting them the right dosage of standing tolerance, activity, tolerance, how we can kind of slowly manipulate those variables to help out the patient and kind of give them their life back, because they feel like they can't do anything.
[00:17:36] The ability to kind of do activities with spinal stenosis, they feel like they can't do much, right? As soon as they stand for five, 10 minutes, they're feeling that heaviness, they're feeling that aching in their legs. And we want to kind of get rid of that and allow them to have their lifestyle back.
[00:17:55] But it's almost the same thing with it. It's how can we moderate activity level according to the patient and see what kind of freedom we can give them.
[00:18:06] Sanjiv Lakhia: Now at our group, I've really noticed the physical therapy approach is slightly different in that we lean on lot, a little more on exercise, prescription and exercise rehab.
[00:18:16] Then we do modalities technologies and toys. Having said that, I know there's a lot of questions out there, they're from the general population about, some of these interventions, let me just kind of toss them out and get your thoughts, opinions on them. One is dry needling, and I did a kind of a compare and contrast episode of dry needling versus acupuncture recently, so if you haven't heard that, feel free to take a listen. I want to get your thoughts on dry needling, electrical stimulation, and then some other, there's the TRX system that is more of an exercise system. Well, we even spoke recently together about the gravity assisted treadmill. So just give me your general mindset about modalities and their place in rehabilitating back injuries.
[00:19:04] And then if you have any specific comments or opinions about the ones I just mentioned, I'd love to hear those as well.
[00:19:10] Eleanor McMillan: Oh gosh. I would love an officer G in our clinic, but yes, modalities have come in many different packages now and I feel like. The physical therapy world is everything is the new rage, you know, and the Olympics that was the cupping and everybody then wanted cupping.
[00:19:28] And then now it's dry needling or myofascial release. Those are kind of the, you know, all the rage terms, but you're right. I think we do try to focus here at our clinic, much more about exercise dosing and prescription, but that doesn't mean that those things don't have their place. Because I will absolutely dry needle someone who I think is appropriate or use Estim, or I love the TRX system we have in our office. I think all of those modalities absolutely depend on getting the patient to their goal, right? So if we can get or help skip a couple of steps with dry needling or Estim, to get to their functional goal, then I think that that is going to help the patient. But what I don't want to do is make a patient reliant on my services or my care with the modality to where they need to come back in, or they feel like they need to come back in every two weeks and not be independent in their own care. Right? So my goal is to get them out of our office. I don't want to see them back, so I don't want to make them reliant.
[00:20:41] Sanjiv Lakhia: I love that. That is exactly. I think why the therapy program here is so effective. One of the reasons that our group in particular focuses on the exercise component is that's where the evidence and the research really is supportive for longterm benefits and sustained benefits with PT interventions.
[00:21:03] I definitely liked the idea of saying that the modalities are tools in the tool box, but the ultimate goal is functional improvement. And if we're doing our job well, patients should need us less or not at all. And that's really the model that I think is a modern day model is what people need. People don't have the time, the money, the energy to come for two, three, four, dozen visits.
[00:21:26] So what we really believe in what I believe personally is if we can teach you how to take care of your back, put you on the right path with proper exercise prescription. And generally you'll do well. And then you can check back in periodically, if you need some dry needling or you need some treatment.
[00:21:40] And as, just as a side note, for those who aren't aware of the TRX system, it's a kind of a cable system. How would you describe that for someone who doesn't know what that is?
[00:21:50] Eleanor McMillan: Probably like suspended straps that you can hook your feet into and also have handles to grab onto. So it's a great body weight assisted training tool to kind of work through multiple different things. You can work upper body, lower body, core all with the straps, that kind of hook in, depending on how you have your setup at home. It is a home set up to where you can do it, like over a door, hooked up through drywall different kinds of connections at home so that you can kind of take the suspension system anywhere with you.
[00:22:28] Sanjiv Lakhia: And then the alter G is a gravity assisted treadmill that has probably more applications in the orthopedic world to allow individuals to walk or run without significant weight bearing effect on a joint. Is that, is that a good description?
[00:22:44] Eleanor McMillan: Yeah, absolutely. They definitely can put you in that zero gravity environment where you can just take all the stress out of kind of rehab, but definitely much more implications for orthopedic injuries and recovery for that.
[00:23:00] Sanjiv Lakhia: I think for spine care, probably a better alternative to that, more practical alternative would just be having people do some movement in a pool because we do know that the water has compressive effects, which help with lymph flow and edema. And it also takes away about half your body weight when you're in the pool. And I've had a lot of patients who've had low back injuries really begin to recover through using exercise in the water.
[00:23:26] Eleanor McMillan: I love that.
[00:23:27] Sanjiv Lakhia: Now we've covered some really good specifics about PT approach for back pain. One of the questions I get a lot is, well, what should I be doing after PT? Like I've gotten better. I no longer have that disc pain or sciatic pain. I want to get back to my general physical fitness goals, like keeping my weight down, cardiovascular fitness up, strength up. And I get asked, what's a safe form of exercise for someone who has had previous back injury. So kind of give me your thoughts on what you recommend to patients as maybe we look at how to approach from the cardiovascular perspective, and then maybe what you think is a safe way to approach maintaining your strengths.
[00:24:10] Eleanor McMillan: Yeah, we get that question a lot. Obviously, I think walking and aquatic therapy or exercise is a great option just to keep the cardiovascular part up. But if you are a previous runner and now you were getting sciatic pain and you want to get back to running, we have a return to running program where it's a much slower advance, back to jogging, and we'll probably do it at much less.
[00:24:37] Frequency to start with trying to keep that, you know, make sure all the work that we've done, all the homework that you've done, you know, stays put and all those glutes hamstrings, all the muscles that we've kind of worked on are staying strong. The biggest key is continuing your home exercises program, but it doesn't have to be every single exercise we give you.
[00:25:01] We give you a huge toolbox by the time you leave here. And so that means maybe I pick a core exercise, a lower extremity exercise, a front of the body leg exercise or back, or the body leg exercise do about four or five of them a day and then alternate or switch it up. It doesn't have to be every day. It doesn't have to be all of them, but we want to get you to the point to where you can do something consistently.
[00:25:30] So, you know, the exercises that really help you and help you with your goals. So we want to keep those up and then it's, you know, I always, my friend coined this phrase "old, not weak" for some of our patients. Now, it's okay, you've done all this work and you want to get back to it, well, I hope when you've left, you almost feel like you're better than you were before.
[00:25:54] So now you can go do your gardening, your household chores. Anything. If you are a golfer, if you, I had a patient in here earlier, it was played disc golf. If you want to go back and do those things, you're now doing them better than you were before, because we're activating the correct muscles and you're keeping up with that program.
[00:26:15] Sanjiv Lakhia: Yeah, that's really good. When the gyms open up, hopefully sometime soon in the midst of this pandemic, people are going to be looking at a lot of options. There's elliptical machines, stationary bikes, recumbent bikes, rowing machines, just to name a few. And I'll kind of give you my take on them. And you tell me if you agree or disagree.
[00:26:35] I think that for most people, the elliptical machine is probably the best tolerated least risk. If you have, let's say history of a bulging disc and low back pain, I think stationary cycling can be done well, but if you're sitting and leaning too far forward for half an hour to an hour, it can trigger some disc pain.
[00:26:54] I've advised people that the rowing machine, which I think is a wonderful all-in-one exercise for cardiovascular and strength and aerobic and anaerobic exercise is fantastic if you do it right. And if you're slightly off in your form, it's a disaster, way too much needed chest fluxion and compressive llection movement on the disc itself, almost squeezing the disc.
[00:27:19] You know, so those are just my general thoughts. I think the recumbent bike, might be a little better version for biking where you can have, have better posture, maintain a neutral spine wall while you're on it. What do you think about those thoughts with those exercise equipment?
[00:27:32] Eleanor McMillan: Yes, I completely agree with you.
[00:27:34] The only thing that I would change is I don't like the ellipticals and I think they're phasing more of them out, but I don't like the ellipticals that have the very large arms swings with the handlebars, just because that puts too much twisting on the low back. And that compressive force gets a little bit, can be a little bit too much.
[00:27:58] So that's one of the few things. So I instead use no hands. If you have to, if your balance is good, that's going to really charge up that core and fire it up or use the stationary handles for if you need to hold on. And I love that forward and backward on the ellipticals. Great. I love the rower. I'm a personal user of it, but even there, I have to be super perfect with my form.
[00:28:22] So I definitely agree with you. If you have low back pain and you are not paying attention to your core and your hips and your back and your chest, you are more than likely when you get fatigued, going to cause some damage to that low back. So I usually tell most patients to probably stay away from it or if they really love it, and it's something that they have at home, go to really moderate resistance so that you're not going to put that much force through that low back and staying very upright. As well, their accumbent bike, I love it. There's nothing really that I would say, except that it doesn't hit a lot of that posterior chain or the backside of your body, enough that to come back, how much we sit throughout the day.
[00:29:07] As for the stationary bike, I agree with you. I think sitting on that seat can get very compressive and you'd have to tinker with it a lot to get the handlebars up to the correct spot.
[00:29:18] Sanjiv Lakhia: Outside of a fair number of patients who love swimming, what's your thoughts on mechanical effects of swimming and some of the different strokes on the low back?
[00:29:28] Eleanor McMillan: I'm okay with swimming. I think, you know, to the extent that you're going to do distance, I think the distance bothers you a lot more than sometimes the stroke that you select freestyle can put more pressure on that low back. Obviously, I don't really think butterfly should be in your game plan with some low back pain.
[00:29:48] I like breaststroke a lot and backstroke. I think those all can kind of in their own right. Be very efficient. Cardiovascular and muscle fatigue activities, but I think it's all done in your correct dosage.
[00:30:04] Sanjiv Lakhia: That's fantastic. I think you've really given some high yield information for people who are going to listen to this and given them some directions.
[00:30:11] So I really appreciate your insights today. I want to kind of just wrap up. I always wrap up my interviews by picking the brains of the people I'm talking to about their health routines. I think health and wellness is such an important topic in this country today. And there's, my belief is there's no one right way, but I know you're very health conscious.
[00:30:30] Do you have any strategies or tips that you want to share with people?
[00:30:34] Eleanor McMillan: For the most part, I try to run or get in some kind of cardiovascular activity two or three times a week. And then I think as a woman, I try to lift heavy. Now heavy is according to what I can lift. I'm not saying go out and lift 200 pounds daily, but I do try to lift heavier twice a week to help out and combat the bone density.
[00:31:02] The benefits of strength training. I do try to lift a little heavier and I think that's had tremendous effect on my strengths, my stamina and staying healthy. And I think I would always promote women lifting a little bit heavier than they can think a couple of times a week, because that's just shown to help out your entire system.
[00:31:23] As we're eating, I am on my own health journey and trying to do better with fruits and vegetables and eating, just trying to do better with my fruits and vegetables.
[00:31:37] Sanjiv Lakhia: Well, look, you're not alone. Everyone's on their health journey with food in particular. So if you have an awareness about it, you're ahead of the game, in my opinion. Do you have any great apps you like to use favorite books or other tools as a last kind of parting gift to the listeners?
[00:31:54] Eleanor McMillan: Oh, that's a good question. I was thinking about it earlier. I've not been on any apps or anything like that. Recently books, I have taken a hiatus from kind of cell phone usage and trying to get away from the dependency of my phone and social media.
[00:32:15] So, I've not been on it and I failed you there.
[00:32:19] Sanjiv Lakhia: Actually, that might be the best advice anyone has given an answer to that question. I think detoxing doing a digital detox is a very healthy thing, Eleanor. So don't change that at all. But listen, I really, really enjoyed the interview today and you throw out a lot of good stuff for people to consider and really thank you for your time today.
[00:32:39] Eleanor McMillan: Thank you for having me.
[00:32:41] Sanjiv Lakhia: And once again, thanks for listening. This has been a real pleasure to put together this information for the podcast. Again, if you'd like to learn more, feel free to check us out at cnsa.com. Also, if you haven't had a chance to take a look at the patient education book I put together, you can find that at backtalkdoc.com. Until the next episode, please take care of yourself and each other.
[00:33:06] Outro: Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health. On the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
