Mary Anne Dicaro, PT

While it is always a good idea to have a doctor check out an injury it is not always necessary. A physical therapist can practice outside of a physician referral and therefore can assess the injury since the musculoskeletal skeletal system is their strength.
If the therapist feels a referral to a medical doctor is needed they will suggest you follow up with a doctor and perform further evaluation or testing.
As I said, if you start with a doctor, they will likely take a quick look at the injury and refer you on to a physical therapist for further evaluation and treatment.
You may also need guidance from a physical therapist on body mechanics and proper weight lifting techniques and strengthening recommendations. They are in a much better position to guide you in that situation.

I am glad you asked this question! Approximately 60%-70% of my patients are overweight. A good physical therapist will work with your unique condition and begin a program that will start you wherever you are. Many people I see are also de-conditioned, have joint conditions and progressive weakness, especially after a year of being isolated, not attending structured exercise, or reducing physical activity due to covid. The success of any program depends on the type of issues you are having (acute, chronic, joint, muscle) any other health conditions (diabetes...) and your willingness to invest some time in yourself. As a therapist and wellness coach, I always start with an individual assessment and take an inventory of your personal goals. It is a must to also address nutrition and other lifestyle factors that will help you achieve your goals.

Spinal Stenosis is a narrowing of the spinal canal or opening where the spinal cord resides and where the nerve roots exit. Depending on the severity of stenosis and the clinical symptoms I have seen many people improve with Physical therapy and decompression type exercises. Since every persons condition and pain is highly variable, some people will show great improvement while others minimal or no improvement. I often consider that the musculature of the core and spine are in a weakened state or conversely may be overly tight or contracted. These conditions both contribute greatly to individual symptoms therefore must be addressed. The type of exercises that benefit this condition most are deep abdominal strengthening and flexion type exercises. The abdominals function to 'decompress' the nerve roots as they exit the foramen and therefore relieve radiating-type symptoms. Flexion exercises however are not indicated if there is also a history of osteoporosis or compression fractures. There is no 'cook book' approach here but an individualized exercise program tailored to each person is the best advice.
I hope you will consider mobility, strengthening, and conditioning exercises before you agree to undergo surgery.

Tennis elbow, or lateral epicondylitis (medical term), is when the tendons that lift the wrist become irritated. These tendons insert on the outside of the elbow( palm facing forward). It is usually caused by repetitive motion, tight muscles or weakness in the muscle. This condition resolves quite well with physical therapy. A combination of ultrasound (with dexamethasone), laser, and electrical stimulation, exercise, stretching, and corrections to the grip and posture usually reduce inflammation and symptoms and correct the underlying condition.

Yes! You can reverse osteoporosis with a combination of lifestyle and dietary changes. Also using Supplements that contain the FULL SPECTRUM of bone-building nutrients, and there are at least 15 of these that work in combination to build healthy bone. Calcium alone is not advisable and can actually be dangerous to take in high quantities without the other nutrients such as Vitamin D, Magnesium, Vitamin K, Vitamin C, boron, strontium etc..... Lifestyle changes to incorporate: focus on a whole-food, plant-rich diet, high in naturally occuring minerals like magnesium and calcium. Reduce inflammatory, acid-producing foods like white flour products, sugar, processed packaged foods, and meats. It is also critical to perform weight-bearing exercises and impact exercises like jumping, walking, running and resistance training in order to stimulate new bone formation. There are many pharmaceutical agents ( drugs) on the market that help reduce bone loss and have been used in an attempt to reverse osteoporosis. Caution is required with these drugs as they have many adverse side effects. Please discuss with your doctor and do your own research before agreeing to take these medications.

Osteoporosis has very few physical symptoms early on. It is diagnosed with a DEXA scan that looks at bone density. Osteoporosis is diagnosed if the DEXA scan, T score is below -2.5. The lower the T score the lower the bone density (-3.0 is less than -2.5). This rating compares your bone density to that of a healthy 30-year-old. Keep in mind that DEXA scans measure the bone quantity, not quality, so they do not provide information on the resiliency of the bone or its ability to resist fractures. Some early signs of osteoporosis might be a dowagers hump, which is a rounded curve in the upper back, some periodontal bone loss, weakness of grip strength or a fracture that is sustained with very little force. Baseline DEXA scans are usually performed prior to menopause in females to get a baseline. Osteoporosis has many causes and bone health in general may be related to diet, inflammation, activity level (weight bearing and strength training are best for bones), medications ( steroids reduce bone mass), other health conditions (Celiac disease, autoimmune disorders....). body type (thin, small boned, underweight individuals generally have lower bone density) and genetics. It is great that you are proactive and considering now what you can do to fend off bone loss and prevent a future osteoporosis diagnosis. Consult a physical therapist or functional medicine practitioner to devise a bone building and preserving program of exercise, lifestyle, and nutrition to stave off bone loss as you age.

Back pain is a problem for many and it has many causes. Treatment and prognosis depend on the diagnosis and cause of pain. Have you had any testing done? If more serious causes of back pain have been ruled out, most of the time, chronic pain, (which is pain lasting over 3 months) is due to a 'mechanical' issue. This simply means it is a result of soft tissue that is under stress or strain due to postural changes, alignment or structural changes in the spine or pelvis combined with muscular weakness or tightness. An individual examination would reveal which tissues are tight, which have become weak or non-supportive and whether or not you have a malalignment of the spine or pelvis that requires correction. Often times, even if there was a precipitating injury or event that 'caused' the pain, the brain is still receiving signals that there is an injury. I would suggest seeing a Physical therapist in your area, for an evaluation and once the underlying factors have been determined they can provide you with an exercise program tailored to your unique and individual needs. Exercise is an effective way to manage chronic pain and get you back to an active life.

Sciatica is a medical term that refers to pain that radiates down the course of the 'sciatic nerve'. The sciatic nerve is a large nerve that is comprised of the nerve roots of the last 3 lumbar vertebrae. It travels through the hip and then sends branches down the leg. There are many reasons why a person will have 'sciatica' like symptoms. An xray may reveal arthritic changes in the spine with narrowing of the foramen where the nerve root exists the spine. An MRI may reveal there is a disc that is herniated or protruding into the space where the nerve occupies. More often than not, the pain is more of a muscular origin, either coming from the back or from a muscle deep in the back of the hip called the Piriformis. The Piriformis lies directly over the sciatic nerve as it transverses through the back of the hip and can put 'pressure' on the nerve if it is tight. Managing this condition is often a combination of stretching the hip, and strengthening the abdominal and core muscles to support the spine and pelvis in optimal alignment. Once the symptoms are reduced it will be necessary to continue the exercises and maintain good postural alignment in order to prevent the pain from recurring.

Mid-back pain can be caused by many things with the musculoskeletal system being just one of them. Do you recall an incident that may have precipitated the pain? A new exercise program, lifting routine, or perhaps sitting for longer than normal at a computer or tablet? A differential diagnosis will include pain referred from the lungs and even the gallbladder. If it is positional, it may more likely be due to muscle strain or a subluxation of the vertebrae. Does massage, heat, or rest improve it? Again, this would be more likely if it is coming from the muscles or spine. If it persists, I would recommend an X-ray.

My suggestion is isometric exercises where the muscles surrounding the knee joint are contracted without putting a strain on the joints themselves. A weakness of the quadriceps muscles (4 muscles in the front of the thigh) is often associated with knee pain in arthritic and non-arthritic knees. I would begin with simple straight leg lifts in a supine position (back-lying). You can find other examples of isometric exercises online.