Sex and Back Pain

Millions of people suffer with back pain. One thing that is often not discussed is the effect it has on sex lives. Every person’s condition is different. In the long run, creativity and the right positions could make your sex life easier. Back conditions can be sometimes categorized into those that do better with flexion or those that do better with extension.
Flexion (bending the spine forward) pulls on the ligaments and muscles and puts posterior pressure on the disc. Ligaments and muscles may hurt more if they are strained, bulging discs may also be injured or damaged further by flexion.
In these cases, you may do better with extension positions. Extension (bending backwards) will ease tension on the ligaments and muscle. It reduces disc stress. Missionary position would work best for a man as long as his back is extended or bent backwards more. He could sit upright in a chair, or put a pillow on his low back and lay down on his back. For a woman the facing forward position in a chair movement works well for the extension, or lying on her stomach.
Other spinal conditions find relief from flexion (especially if you have a bony lumbar stenosis, or any other conditions).
Positions incorporating flexion for a man would be “spooning” or “entering from behind” which allows him to bend his spine forward. A woman who would like to incorporate flexion into intercourse may opt for the missionary position with her knees bent up or straddling her partner bending her spine forward.
Overall, use the flexion and extension principle during sex/ sexual positions. It is important to use a firm surface with pillows or rolled up towels for support of your back. Certain positions can be avoided all together while others can be more comfortable over time with exercise.
The next thing is to communicate with your partner, which really is overall the most important. Communication is crucial; you don’t want your stress from your back pain to make your partner feel rejected leading to hurt feelings furthering each other away. Tell your partner what is going on, let them know that you have a plan and get them involved with your plan. If intercourse is too painful on the back, try something else intimate, don’t ever lose that spark!
For more information a good resource is the book, Sex and Back Pain by Lauren Andrew Hebert, P.T.

Preparing for Ski Season

We haven’t had snow but I bet it is on the way…   For those of you who like to downhill or cross-country ski, it’s good to get those legs in shape pre-season!!  When you do finally go skiing, you will have more endurance when you start out and less soreness the next few days!

The most important muscle is the quadriceps, the big muscle along the front of the thigh.  It is important to train the muscle in a similar way to how it will be used.  For skiing downhill, that means moderate flexion and long “holds.”  A great exercise for that is a squat at the wall.

  • Stand with your back against a wall, placing your feet about two feet out in front of you. Feet should be hip-distance apart.
  • Bending your knees, slide your back down the wall until your knees are at 90 degree angles. Your knee joints should be over your ankle joints, so you may need to inch your feet further from the wall to create proper alignment. Your thighs should remain parallel.
  • Hold for 30 to 60 seconds, and then stand up. Repeat for a total of three reps.
  • To make this move more challenging, alternate between lifting your left heel for a few seconds and then your right. This helps to target your calves.

Following the wall squat, it is good to stretch the quadriceps as well.  In standing, bend your knee behind you, grab the foot and pull to stretch this same muscle.  Stretches should be held 5 – 10 seconds and done 3 – 5 repetitions.

If you are more of a cross-country skier, you would need to do frequent short contractions, so slide up and down the wall repeatedly (50- 100 repetitions – think about how long you would be skiing – an hour??!!).  Another option for cross-country skiers would be the “lunge-walk” to strengthen the quads and gluts.

STEP 1: Stand with feet hip-width apart. Keep your arms straight and hold your dumbbells at your sides.
STEP 2: Move your right foot forward, bending both knees and with the left knee pointing towards the floor. Keep your upper body straight.
STEP 3: Slightly straighten your legs and do another Lunge. Step forward using your left foot and bend both knees. Keep your arms and dumbbells at your sides until you finish the exercise.

Shovel Safe!

Shovel Safe!   Avoid Injury this Winter.

In Maine, snow shoveling is a fact of life.  Given the musculoskeletal and cardiovascular demands of this activity, it’s no surprise that injuries are common in the winter.  You are particularly vulnerable to back injury when shoveling, so it’s important to keep in mind proper body positioning and technique.  According to the Canadian National Occupational Health and Safety Resource (CCOHS), your snow shovel should come up to chest height.  Using a light-weight shovel, around three pounds, will decrease your workload and increase efficiency, allowing you to get this hated chore over with faster.

When you stand, you naturally have an inward curve in your back.  It is important to maintain this curve while shoveling to avoid back injury.  Grip the shovel with one hand on the handle and the other as close to the bottom of the shovel as possible.  Stand in a lunge position, with your feet wide apart.  Bend your knees, putting your weight on your front leg to load the shovel; when you are working quickly, the load should not exceed 10-15 pounds (CCOHS). Straighten your knees and use your leg strength to lift the snow.  Ideally, you should throw the snow directly in front of you about 3 feet; if you have to throw it in another direction, move your feet in that direction. NEVER twist at the waist or throw the snow over your shoulder!

You may also consider:

  • An ergonomically designed shovel, which as a bent handle rather than a straight one.  Studies show that these shovels reduce strain and discomfort in the low back, arms, and wrists.
  • Dress in warm, light-weight clothing that allows free movement.  Your innermost layer should allow sweat to escape from your skin surface.
  • Shoveling is a work-out, so it’s a good idea to warm up by stretching and walking briskly for a few minutes to get your muscles ready.  While shoveling, pace yourself and remember to hydrate (and no, beer does not count as hydration).
  • When you’re done, follow up with the backbend stretch.

Shovel safe, and have fun in the snow!

By: Anne Knowles, PT, and Jennifer Wolfe, SPT.

At this time of year, many homeowners will be getting their exercise by raking leaves.  Raking is a physical activity that can help individuals stay active, but raking is often accompanied by the strains and pains associated with repetitive motions.    Fortunately, this can be prevented by safe practices and good body mechanics.

Most important is to alternate sides so you don’t over-use all the joints and muscles.  It will feel funny at first because you probably prefer raking to one side, but it can be done and will make a big difference!

Another small thing is to break it up into small segments.  You don’t have to get it all done in one day!  Split the job into 30 minute segments.

When you are raking, hold the rake handle close to your body – don’t stretch too far out with it.  Use your legs and make it into a lunge exercise – DON’T TWIST THE BACK! Reach out and pull back   Avoid the tendency to plant the feet and rake in several different directions from that position.  Instead, place one foot ahead of the other and shift forward and backward as you pull.

The other troublesome part of raking is the bagging of the leaves.  This usually includes frequent bending and lifting of awkward loads.  Keep the loads manageable.  Use your legs to do the lifting and don’t twist.  Don’t overreach to get those last few leaves.  When lifting the bags of leaves, tense your belly muscles to give your back extra support and keep the bag close to the body while you bend your knees, keep your back straight and your head looking up.

After the job, do the backbends preventatively and maybe even rest on your stomach on the floor for a few minutes.  If you have sore leg muscles the next day, be happy.  That means your legs got a good workout, but you didn’t strain and injure your back!!!  If you do strain your back, do the standing back stretch for a few days.

Just a reminder.  Next week is our first free clinic of 2014.  It's called understanding and Managing Low Back Pain.

When: Wednesday, January 15th at 5:30 pm.

Where: Brewer Physical Therapy and Spine Clinic 51 Main Rd. Holden, ME 04429

Join us for a session of informative discussion, education, and exercise aimed at decreasing or preventing low back pain---free of charge! Get your questions answered and receive a free consultation by Licensed Physical Therapist Anne Knowles.  Whether occasional or chronic, anyone who suffers from back pain is welcome to attend. The clinic will cover helpful topics such as:

  • Anatomy of the spine
  • Common causes of low back pain
  • The difference between muscle strain, bulging discs, arthritis, and stenosis, four common low back complaints
  • Simple exercises to relieve discomfort
  • When to use heat or ice
  • Flex or extend? Stretch or Strengthen? Learn different types of back exercises

This FREE session will be directed by Licensed Physical Therapist Anne Knowles, the only therapist in the Bangor area certified by the McKenzie Institute in Mechanical Diagnosis and Treatment. Call us at 989-4122 to reserve your seat today!!

“Spring Training” – aka - Muscle Strains and Their Prevention

As I write this, it makes me remember it is Opening Day at Fenway!  Although none of us are professional athletes (or we wouldn’t be here and wouldn’t be reading this article!!), living in Maine does lead us to the tendency to increase our activity level significantly in the spring (sometimes from a winter of hibernation).  This often leads to a condition called “delayed onset muscle soreness.”  This is the pain and stiffness that you feel 24 – 48 hours later.

Originally, the explanation for the soreness was accumulation of lactic acid left in the tissues.  More recently, however, it has been found this is not the case.  The current belief is that it is merely micro-tears in the tissues.   Muscles are made up of bundles of fibers inside an outer sheath or covering.  When a muscle contracts, the fibers shorten by linking and sliding together.  When they are overloaded, the fibers reach a breaking point and a partial tear occurs.  As we age, our tissues become less pliable, therefore this is more likely to occur.

The healing process begins with inflammation that lasts 3-5 days.  This is a crucial time during which rest and protection of the injured part is vital to prevent further damage!  The body produces chemicals which remove dead muscle fibers and starts the repair process.  The bleeding inside the muscle causes a scar to anchor the 2 ends together.

You should use the PRICE principle to assist with the healing.

P = Protection   ( positioning, not overdoing it)

R = Rest

I = Ice         (10-20 minutes, every 2 hours for 3 days)

C = Compression     (ace wrap)


After these 3-5 days, begin with stretching, then progress to gradual progressive strengthening.

If you do find yourself sore after a tough workout or competition, these are recommended methods to deal with your discomfort. Although not all are backed up with research, many athletes report success with some of the following methods.

  • Use Active Recovery. This strategy does have support in the research. Performing easy low-impact aerobic exercise increases blood flow and is linked with diminished muscle soreness. After an intense workout or competition, use this technique as a part of your cool down.
  • Rest and Recover. If you simply wait it out, soreness will go away in 3 to 7 days with no special treatment.
  • Try a Sports Massage. Some research has found that sports massage may help reduce reported muscle soreness and reduce swelling, although it had no effects on muscle function.
  • Try an Ice Bath or Contrast Water Bath. Although no clear evidence proves they are effective, many pro athletes use them and claim they work to reduce soreness.
  • Perform Gentle Stretching. Although research doesn't find stretching alone reduces muscle pain of soreness, many people find it simply feels good.
  • Try a Nonsteroidal Anti-inflammatory. Aspirin, ibuprofen or naproxen sodium may help to temporarily reduce the muscle soreness, although they won't actually speed healing. Be careful, however, if you plan to take them before exercise. Studies reported that taking ibuprofen before endurance exercise is not recommended.
  • Try Yoga. There is growing support that performing Yoga may reduce DOMS.
  • Listen to Your Body. Avoid any vigorous activity or exercise that increases pain.
  • Allow the soreness to subside thoroughly before performing any vigorous exercise.
  • Warm Up completely before your next exercise session. This is more important than stretching before exercise.  There is some research that supports that a warm-up performed immediately prior to unaccustomed eccentric exercise produces small reductions in delayed-onset muscle soreness (but cool-down performed after exercise does not).
  • ** If your pain persists longer than about 7 days or increases despite these measures, consult your physician or physical therapist.
  • Learn something from the experience! Use prevention first.

Tips to Help Prevent Muscle Soreness After Exercise

While you may not be able to prevent muscle soreness entirely, you may reduce the intensity and duration of muscles soreness if you follow a few exercise recommendations.

  • **** Progress Slowly. The most important prevention method is to gradually increase your exercise time and intensity. Use the 10 percent rule for exercise progression guidelines (increase by 10% per week with regards to intensity, distance, time and eight lifted). *******
  • *** Warm Up thoroughly before activity and cool down completely afterward. ***
  • Cool Down with gentle stretching after exercise.
  • Follow the Ten Percent Rule. When beginning a new activity start gradually and build up your time and intensity no more than ten percent per week as above.
  • Hire a Personal Trainer if you aren't sure how to start a workout program that is safe and effective.
  • Start a new weight lifting routine with light weights and high reps (10-12) and gradually increase the amount you lift over several weeks.
  • Avoid making sudden major changes in the type of exercise you do.

Remember your Micro-Stretch breaks!!

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Why Exercise?

Exercise is an important part of healthy living for everyone. However, for people with PD exercise is not only healthy, but a vital component to maintaining balance, mobility and daily living activities. Parkinson's symptoms such as tremors, freezing and slow movements can limit the ability to walk, get in and out of a chair, and participate in daily activities.

Did you know exercise could actually help slow the progression of PD?

How to get started!!

Brewer Physical Therapy and Spine Clinic is offering a new exercise program specifically geared toward helping Parkinson’s patients maintain their mobility and strength, improve balance and flexibility and overall quality of life.

For more information please contact us:

Brewer Physical Therapy & Spine Clinic

51 Main Rd., Holden, Me 04429

Phone: (207) 989-4122


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It’s too late now for pre-season training but here are some exercises to help your paddling strength, endurance and power.  Most rowing and paddling endeavors rely heavily on strength, endurance and integrity of the muscles involved around the shoulder joint, including the pulling muscles of the lats, rhomboids, and biceps, as well as the core muscles (abdominals and obliques, the muscles that allow us to rotate and twist through the torso) and forearms (involved in gripping). The muscles that tend to be under-trained or somewhat neglected are the pushing muscles, including the pectorals and triceps, the lower back muscles, crucial to core health and integrity, and the forearm extensors.

Exercise #1 – PUSHUPS

The old standard of pushups has many variations but is a great exercise for the muscles needed for paddling sports.  It requires no equipment and can be done anywhere, anytime!

Exercise #2 – BENT-OVER ROWS

Bend over at the waist with your arm supporting your body weight on a chair back or table and knees slightly bent (to protect the back).

Hold a small weight in your free hand and let it hang down toward the floor.  Then pull it back bending the elbow  and repeat.


Sit on the edge of a chair or on a stool or box so you have free space around you.  Hold 2 paddles or oars for added weight and simulate paddling.  Start with 1 minute of paddling and progress to build up your endurance.  You can also add weight to build more strength by using something attached to the paddle or a weighted pole.

Stay cool and have fun!!!

As our days get longer and warmer, I find myself venturing out more.  If you do, too, you may find these warm-up and cool down stretches helpful.

According to, in the field of sports, backpacking/hiking stands alone as the only endurance sport in which the participants do not regularly perform a warm-up. Distance cyclers and marathon runners have long benefited from a good stretching routine before exercising. Stretching gradually increases heart rate, temperature and circulation to your muscles. Basically, stretching is like warming up your car on a cold morning. After a night's rest, your muscles need warming. Stretching gets the body going and increases your flexibility.

"Muscles or joints that lack adequate flexibility are more susceptible to injury," says Dr. Frank C. McCue, III, Director of the Sports Medicine Division of the University of Virginia Health Sciences Center. "Good flexibility can prevent injury and enhance performance."

How to Stretch

When beginning to stretch, pick a level spot free of stones and sticks. Each of the stretches described in this article should be held for at least 10 seconds at the point of tension, during which time the tension should begin to decrease. Exhale as you lean into the stretch. During the stretch, you should relax and breathe steadily. Do not bounce during the stretch. Bouncing can tear at the muscles and tendons, creating damage that won't be able to heal as you hike. Also, do not overstretch. That is, don't push yourself too far. A small burning feeling is all right, pain is not.

Any or all of the stretches listed are also helpful during the cool down period after the walk or hike.

Calf Stretch

  • Find a flat rock or stump that offers enough room for you to stand several inches off the ground.
  • Stand on the rock and back your feet up so that your heels hang off the rock.
  • Lower both heels until you feel the stretch in your calves.
  • Raise both heels, then alternately lower your right then left heel, stretching each for 10 seconds.
  • If you have a hiking partner, he/she can help you keep balanced.

Quad Stretch

Another muscle that needs warming up is the quadriceps, along the front of the thigh.
1) While standing, hold onto a tree to assist in balance.

2) Bend your knee back by grasping your ankle with one hand.

3) Assist in bending your knee back as far as possible.

4) Maintain position for 10 seconds.

And Then.... Go have fun!

For those of you who like to golf, it’s good to get in shape pre-season!!  You will have more endurance when you start out and less soreness the next few days, not to mention it may improve your game!

There are 5 physical aspects to golf.

  • MOBILITY will give you optimal swing angles
  • STABILITY will give you a consistent swing
  • BALANCE AND BODY AWARENESS is for a solid base
  • STRENGTH will give you fatigue-free golf
  • EXPLOSIVE POWER for those longer drives

Of course, to get EXPLOSIVE POWER you need to have a stable base with good balance and stability, as well as the mobility to get the club where it should be and the strength to send the ball flying!  So you really can’t just focus on the one area.  But if you know you have a weakness in a certain physical aspect, you might spend more time there.

I will highlight one exercise in each area.

MOBILITY: Spinal mobility is key, as it allows the pelvis and shoulder to move as they need to.

Do these stretches with a 5 sec. hold, for 10 repetitions daily.  The standing one can be done holding to the pole of the golf cart before and/or after you play.


To prevent hip sway and slide, and to allow consistent flush contact with the ball, try this:

Stand on 1 leg.  Move your arms into a T and bend at the waist.  Rotate your torso left, then right for 15 repetitions.  Switch legs and repeat.



From the top of the backswing to contact with the ball to follow-through, you have 1/5 of a second!  The golfer needs to accelerate the club from 0 mph to 100 mph at impact.  Power is the ability to perform strong movements very quickly.  For power in your swing, you need to build up your strength, but also to incorporate speed into your exercises…  to train the body’s nervous system to react faster.  Be sure to warm-up before doing your power drills, because there is more risk of injury with increased speed.

Using a medicine ball and doing throwing drills is helpful.  Also fine-tune your pushup into a “Plyometric Pushup” by pushing as hard and fast as you can, so that your hands come off the ground.

Get in your usual pushup position.

Lower toward the ground. Then pushup hard and fast

so your hands come off the ground.

Land with your elbows bent slightly and repeat.

See you on the course!!!

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