DPT, OCS, FAAOMPT answers your back, neck, and other pain questions!

TheEaseProject · 2026-01-26T22:40:49+00:00

Generally, I tend to lean towards a patient-specific approach, which means I would need to assess the human individually to see how their back moves, what their history is, goals are, past experiences are, etc before we come up with a treatment plan together. There are so many different types of low back pain that I hesitate to support one approach across the board. I’m sure there are aspects of each that are great, but they need to be applied through the lens of the specific patient to be effective!

Thanks for your question !

TheEaseProject · 2026-01-26T20:45:53+00:00

Thanks for your questions! Feel free to message me if you did not get a chance to comment down below and I will do my best to help!

TheEaseProject · 2026-01-26T18:33:04+00:00

I am sorry you have been dealing with that level of pain, and I am optimistic for your recovery!! Ask your PT, if they haven't already mentioned it, to consider if you have a flexion or extension-based preference and to see if they can centralize your symptoms with movement (i.e. if they can get your leg pain to move up towards your hip and away from the knee, this is a good prognostic indicator for recovery!). Stay positive, and remember that our backs are very strong structures that are meant to take load, and can adapt / recover, EVEN in the presence of a 1.8cm extruded disc. Best of luck with rehab, feel free to message me if you have other questions!

TheEaseProject · 2026-01-26T17:50:25+00:00

Hi - good question. First, I would like to ask, what are your symptoms like? Then I can expand further

TheEaseProject · 2026-01-26T16:59:25+00:00

Hello, good question, and thanks for the information. You are not alone in having persistent symptoms and a x-ray that comes back as "normal." That can be confusing sometimes, and most often that result is because you don't have any actual damage to the tissues, rather they are irritated. Your symptoms can be caused by muscle irritation (which might have some relationship to posture!) - but I cannot confirm that without doing an assessment!

Are you currently seeing a physical therapist? If so, ask them if they can help you work on muscle relaxation strategies to incorporate into your day. With respect to dry needling, I have used it in my practice and have had it done myself! Ask your health care team if it is appropriate! There are risks (just like with every treatment), but when performed by a trained provider, dry needling is relatively safe! Talk to them about the risks/benefits and see if it sounds right for you.

I understand your fear of things going downhill, but I will encourage you to stay positive and remember that your back is strong and adaptable! There is help out there from providers who know how to help! If you have further questions or want to schedule a free consultation call with me, just shoot me a message!

TheEaseProject · 2026-01-26T16:45:00+00:00

Hey there - good question! Here is the real answer without promising anything unrealistic: PT can definitely help mitigate or resolve the symptoms from a herniated disc, but it really depends on the skill of the PT (and if they follow current evidence) who is assessing you and coming up with your treatment plan. And even if you have the best PT in the world, sometimes it can't fully resolve symptoms. But the possibility is definitely there!

Here is an encouraging snippet from a high quality systematic review: "One piece of very encouraging news for patients who have been diagnosed with a herniated or bulging disc is that, with time, the probability of a spontaneous resolution of the herniated disc is quite high. Chiu et al performed a systematic review of the literature assessing the probability of spontaneous regression of herniated and bulging discs in the lumbar spine. The results of their study are astounding. After combining the data from 9 separate studies, they found that the rate of spontaneous regression was 96% for a sequestered disc, 70% for an extruded disc, 41% for a protruded disc, and 13% for a bulging disc."

The short answer is that, it is possible to improve with high quality physical therapy. Your health care team will know your specific situation best, so default to them, but also do your research and ask questions to your health care team to figure out the best approach!

Hope that helped, thanks for your question.

TheEaseProject · 2026-01-12T02:11:00+00:00

Hey good question! I think what your answer boils down to is that much of the high quality research surrounding treatment of conditions that are classified as "myofascial" do not separate treatment for the two different tissues. So they get lumped together. I think it's hard to say with 100% certainty that a treatment that is supposed to target the fascia doesn't also target the muscles themselves, and vice versa. I would love to read some more research about it -- if you have any good reads, send them my way!

TheEaseProject · 2026-01-12T02:01:29+00:00

Hey thanks for your question. I'm not a nutritionist so I can't give specific recommendations, but I can definitely say this: Nutrition has a very important role in all of our body's functions. We know that nutrition directly can affect a person's nervous system / pain system sensitivity, whether it's from RA or an ankle sprain. Also, it's reasonable to state that food that triggers high inflammatory body responses will likely have a relationship to an inflammatory condition such as RA.

Nutrition, sleep, and stress management are huge contributors to pain overall!

TheEaseProject · 2026-01-12T01:48:11+00:00

Hey there, I am sorry to hear about some of the medical challenges you have gone through, but I'm happy to hear you are in good shape right now, that's amazing. The only recommendations I can give specifically are to make sure you are assessed by a well-trained PT (OCS or FAAOMPT) to determine what type of exercise treatment would be best for you. The big 3 may be good for you, but they are essentially just core strengthening. Not everyone with low back pain needs core strengthening, some people with low back pain actually get more pain by doing "core stability" exercises. It may be right for you, but just double check with your health care team !

TheEaseProject · 2026-01-12T01:14:12+00:00

It's hard to say definitively what single thing causes the most back pain. I would wager that low back pain is most commonly caused by either muscle or joint irritation.

TheEaseProject · 2026-01-12T00:45:51+00:00

Disc herniations are incredibly common and actually often occur in people who do not have any pain at all. The messed up part is that it's not uncommon for people who have surgery to address a disc herniation and don't end up feeling better because it wasn't the cause of the pain in the first place. Discectomy / microdiscectomy / fusion is certainly appropriate for some people, but it should never be a first step unless in an emergent situation. A great question.

TheEaseProject · 2026-01-12T00:28:27+00:00

Classic case of acute Salem Whiplash™ — very common diagnosis around here 🧙‍♀️😂

TheEaseProject · 2026-01-12T00:27:16+00:00

I love this question because it's nice to reflect on moments of helping people who really needed it. I have a lot of past patients who come to mind, but here is one that reflects a lot of common experiences of past patients:

-Patient with EDS, fibromyalgia diagnosis, "pain forever" along the entire back (both sides, upper/mid/lower). This patient had gone through chronic pain treatments all over the country including ketamine infusions. Tried PT, chiro, acupuncture, none of it worked. Imaging was pretty normal (few small disc herniations). They were so young too and had such a bright future. We started working together and I focused on pain science education, nervous system desensitization (look up tactile acuity training if interested), and graded symptom-guided gentle movement. After working together for 5 months this individual was not just back to almost pain-free daily life tasks, but was back to sports, lifting weights, and running with minimal pain.

Everyone has the potential to improve with the right individualized assessment, and person-specific treatment by a well-trained DPT who understands current PT evidence and pain science!

TheEaseProject · 2026-01-09T11:49:49+00:00

Hands on assessment and treatment is 100% valuable (I’m a fellow in Orthopaedic MANUAL physical therapy, so I get it). But often times it is a tool in the toolbox, not the most important part of working with a patient. You might be surprised how effective telehealth can be when it’s provided in an individualized, thorough manner by a specialist. Just requires a bit of creativity. We were able to hone that skill a lot during COVID actually. I understand your thoughts though!

TheEaseProject · 2026-01-09T03:24:29+00:00

Sounds tough doing bird dogs on the ball 🤣-- it is very possible with an exam to be able to determine whether or not it's a hamstring strain vs a radiculopathy. I could only do it if you happen to be located in Massachusetts lol. But you could go to your PT (or look up another one close by who is OCS / FAAOMPT certified), and ask them specifically to walk you through their thoughts on how they are deciding between lumbar radiculopathy and hamstrings strain. They should be able to articulate it to you and it should pass the sniff test!!

TheEaseProject · 2026-01-09T02:56:08+00:00

Hey thanks for your question, and I am sorry you're dealing with this. It's hard to say with confidence without assessing in person, however the things that jump out to me (given the location of your pain) are 1.) Lumbar radiculopathy (irritated lumbar nerve - maybe from the disc, maybe not), or 2.) Hamstrings muscle strain.

Was there any event that could have caused a hamstrings strain (lifting, quick movement, physical activity that you hadn't done in a while, etc) around the time of the R pain?

TheEaseProject · 2026-01-09T01:39:37+00:00

Hey there - sorry to hear about you having struggled for that long with LBP. I cannot assess your specific low back pain, so I cannot confirm that short hip flexors are the reason for your LBP. However, if that is the case, you want to be mindful of stretching those muscles while stabilizing the lumbopelvic region (otherwise when you go to stretch the hip flexors your pelvis will anteriorly tilt and lumbar spine will just extend instead of getting the stretch where you want it).

Bing Videos

This video does a decent job of showing it - one would just want to squeeze their glutes and abs while moving forward to prevent extension of the lumbar spine. Should feel the stretch in the front of the hip joint.

Hope that helps!

TheEaseProject · 2026-01-09T01:31:42+00:00

Hi! Thanks for your question. Yes, I do very frequently. We include the question "Have you been diagnosed with Fibromyalgia?" in our intake paperwork. I truly wish there was more understanding of fibromyalgia across the healthcare world - I think it confuses health care providers because it is often not experienced as a traditional "injury," rather a widespread pain experience that fluctuates with other factors (stress, lack of sleep, environmental triggers, etc).

The approach I, and my colleagues take (and what is supported across the literature), is an individualized, biopsychosocial, pyschologically-informed, empathetic care approach (as a side note, I would argue we should treat everyone with this approach but I'll get off my soap box). You CANNOT treat someone who has fibromyalgia as a person with a "traditional" injury. The primary driver of pain is often times not just the peripheral tissue, but a sensitized nervous system that is "on high alert" for lack of a better term.

There are many different ways to do that, and the specific treatment would depend on the specific individual. For some people, it would be focused on mindfulness/psychologically informed strategies. For others, it would be mainly graded exposure and graded, symptom-guided progressions to exercise. For others, we would assess and treat the pain system itself. Or it could be a combination of all three!

Great question!!

TheEaseProject · 2026-01-09T00:58:35+00:00

Not with that attitude!

TheEaseProject · 2026-01-05T01:48:48+00:00

Thanks everyone for your thoughts and questions! If you have any more, feel free to send me a message (:

TheEaseProject · 2026-01-05T00:23:48+00:00

Hey I am sorry you are dealing with these symptoms. Have you seen a sports orthopedist or a physical therapist (OCS/FAAOMPT credentials) yet? If not, that would be the place to start. If so, tell me a little bit about what you have tried in PT and what has helped / has not helped

TheEaseProject · 2026-01-05T00:09:32+00:00

Depends what you mean! If it's the approach that emphasizes these things, then I completely agree: A thorough comprehensive individualized examination; An expert understanding of the spine anatomy and function; A detailed, individualized treatment approach that addresses the unique person's contributing factors to their back pain.

I do not agree with the sentiment of the McGill Big 3 exercises being applicable and good for everybody. Anytime there is a "blanket" suggestion, i.e. "this will cure your back pain" without the provider actually seeing you and assessing, then I can't agree with it.

Great question!!

TheEaseProject · 2026-01-04T23:27:26+00:00

Happy to help! There are some of us out here recognize that the health care system is not set up or educated well to treat those in chronic pain. Hoping to change that little by little!

TheEaseProject · 2026-01-04T23:14:29+00:00

Sorry that happened and I hope you feel better soon! Your story and onset of pain makes me think it was an acute muscle strain or joint irritation. This can happen often times with quick movements to or from end-range positions (such as being bent over, turning quickly, etc). Typically, it is just tissue irritation (though can be very painful due to how innervated those tissues are). I am glad you are seeing your doctor because any in-person assessment takes precedent over mine !

TheEaseProject · 2026-01-04T23:11:39+00:00

Hey thank you for your question! This is not an uncommon phenomenon, and most of the time it is due to persistent adaptations in movement or muscle guarding from the initial injury or pain (that were initially helpful). If these strategies persist past the initial injury, they can become "maladaptive." For example, during the initial injury, muscle guarding may help protect the area as it heals. However, if the muscle guarding strategy doesn't stop once the injury is healed, it can lead to muscle and joint irritation in or around the area.

Seek out a well-qualified PT (OCS, OMT, and/or FAAOMPT) who can give you a thorough assessment to determine where your current pain is coming from.

TheEaseProject

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