Low Back Pain Truth #3

Hello again,

Sorry for the somewhat long break, but I am back to blogging once again.  This is a continuation of the previous 2 blog posts, if you have not read those first, please take a moment and read them prior to this one. (scroll down)

back traumaToday’s post is about a common low back pain myth dealing with the misconception of intensity of pain being linked to the amount of damage occurring in your back.  Logically, this idea makes complete sense.  More pain must equal more damage, right?  Lucky for us, your body is anything but logical when it comes to pain and how much you feel.

In order to understand your back pain more, it is important for you the reader to have a better understanding on what pain is, and what we currently know about pain.

  1. Pain is an alarm.alarm pain
    1. Its function is to let us know that either damage has occurred, or could occur.  A large part to my job is to figure out if your pain is from tissue damage, or the perceived threat of possible tissue damage.
  2. With a new injury (~15 days), pain is good at telling us that we do have tissue trauma.
  3. Once pain has lasted for several days to weeks, the link between tissue trauma and pain weakens.
  4. Pain is NOT a good indicator of where the tissue damage is occurring.
    1. An example is when someone has a heart attack.  That person may experience pain in their jaw, back, or arm.  None of these locations are the areas of active tissue damage, yet they hurt all the same.
  5. Pain can even occur without damage.phantom-limb
    1. Ever heard of a thing called phantom limb pain?  It is when someone who has lost an appendage reports pain in the lost hand/foot, even though the tissue itself is gone and the area leading up to it is healed.
  6. You can even have no pain with lots of damage.
    1. A great example of this was when I was a teenager, my toe was crushed by a boat during a stormy day on the water.  I felt no pain, until I looked down and saw the damage that occurred.

Due to these 6 facts about pain, we cannot assume pain=tissue damage.  What I want you to take away from this new knowledge, is that pain is a poor indicator of tissue damage, location of pain causation, and gets worse at these as time goes on from the onset of your pain.  While pain in itself is never enjoyable, I hope you can find some relief from these above facts.

disclaimerOf course, this is just the basics when it comes to pain knowledge.  In order to fully assess the variables that affect your back, an evaluation from a trained Physical Therapist would be the safest and quickest road to recovery.  Our job is to assess how you move, your overall strength and functional ability, in order to recommend your change in life from being in pain to being pain free.

This is what I do every day.  If you have a question about your pain, or would like to be evaluated by myself, please give Altitude Physical Therapy a call at 303-781-3456.

Stay Healthy and Active!

-Joel Fredrickson, PT, DPT


P.S. I would love to hear about new ideas/questions you may have that I can use for upcoming blog posts.  Thanks in advance for any ideas you have!





Reference list:

  1. Lehman, G. Pain Fundamentals: A pain science workbook for patients and therapists.  http://www.greglehman.ca/pain-science-workbooks/. 2014







Low Back Pain Truth #2

Here is the continuation of a series of mini blogs that will be occurring over the next few weeks.  If you missed Low Back Pain Truth #1, please read the previous post before starting this one.

MRI low backWorking in an Outpatient Physical Therapy clinic, I have at least one person a day tell me about their low back MRI results. Lots of times, the results show that they have at least a couple of bulging discs, arthritic changes, and several bone deformities. While all of these sound horrible, my goal today is to tell you that while they can be pain generators, some, if not all of them, can be part of the normal aging process.

what_is_this_normal_you_speak_of___by_1244studio-d50vxxl.pngI am sure many of you are thinking that degeneration in your back is not “normal.”  Well, lets think about this.  As we age, we see degeneration in our skins ability to repair, our tendons ability to accept and transfer force, our muscles ability to fire rapidly and with large amounts of strength, our bones ability to repair and not fracture under force, our hearts efficiency with pumping blood, etc.  The list can go on and on about how our body, over time, starts to degenerate.   Many, if not all, of the above mentioned “normal” aging processes are accepted, so why are we hesitant to accept this in our low back?

The spine, along with the ligaments, bones, muscles that surround it, go through the same aging process as the rest of our body.   In a recent study, looking at over 3100 people without back paindisc degeneration was found in 37% of 20 year olds, 80% of 50 year olds, and 96% of 80 year olds.  Similarly, in people without back pain, disc bulging was found in 30% of 20 year olds, 60% of 50 year olds, and 84% of 80 year olds. (Brinjikji, 2014)

smoking age joke.jpgWhat this shows is that some of us start to degenerate or “age” quicker in the spine than others.  Just like we all start to age at different times with regards to skin changes, hair loss, changes in vision, reduced joint range of motion, etc.  The important thing to understand, is that none of this degeneration was linked to pain.

Again, if most of the population goes through a process in their body, we can then label it as “normal” and hopefully remove years of fear and anxiety when we read our MRI report.

I am not saying that MRI results don’t show anything useful and should be avoided. Actually, MRI results, when correlated with certain symptoms, like weakness in the legs, changes in walking abilities, or changes in bowel or bladder habits can pinpoint the likely region causing these symptoms, and help medical professionals, like myself, develop the best plan of care for your return to function.

What I am saying is that sometimes, we rush into getting the MRI without the correlation of symptoms and that “normal” findings on the report then cause anxiety, fear, and worry.  Thus, leading to a longer road to recovery.

If you have any questions about this latest blog post or would like to schedule an appointment to be evaluated in order to reduce your symptoms.  Please either comment below or give Altitude Physical Therapy a call at 303-781-3456.

Stay healthy and active!

-Joel Fredrickson, PT, DPT



  1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. 2015;36(4):811-816

Low Back Pain Truth #1

low back painLow back pain.  Those three words can change your life.  I have heard of patients who have changed their chairs, bed, car, and activities they love in order to avoid this terrible monster.  What can be done to help individuals with this ever so common complaint?

Increasing your understanding and knowledge on this region of your body can have a huge, positive impact on your return to pain free life.  Interestingly, 80% of individuals will experience low back pain at some time in their life.  Therefore, my goal is to write about a few of the common misconceptions of low back pain and the truths that go along with them over my next few blog posts.

Low back pain truth #1-you have back pain, so it is better to rest right?  WRONG! Multiple studies have shown pain reducing benefits of exercises after individuals have an acute flare up of low back pain.  Moreover, a similar amount of studies have shown the negative impact of bed rest.

Let’s keep this very simple.  Spine movementsThe back is capable of bending forward, backwards, sideways, or rotating. Most likely, some of these movements will create more low back pain and should be avoided in the short term while others will actually reduce symptoms.  If you find one movement that reduces your symptoms, try doing a few more reps.  If this continues to reduce your symptoms, do this movement every couple of hours, to keep your symptoms lowered throughout the day.

Some of you reading this blog may not find a movement that reduces your symptoms.  Or you may find a movement that causes your low back pain to reduce, but you end up having more pain in your legs.  Both of these cases would require a more in-depth evaluation from myself prior to progressing your rehab.

This advice is not all encompassing and should not be utilized for every situation.  This is intended for individuals who have a short episode of low back pain that did not occur because of trauma, an accident, or surgery.  This also should not be utilized in individuals with numbness or tingling down both legs.  Each of these scenarios would also warrant further testing and a complete evaluation by myself.

As always, I would be happy to evaluate you further in order to reduce your symptoms and get you back to your life as soon as possible.  Please either comment below or give Altitude Physical Therapy a call at 303-781-3456.

Stay healthy and active!

-Joel Fredrickson, PT, DPT

4 Ways to Reduce Knee Pain While Hiking

MaroonBells.HeatherRousseau[1]_1.jpgHiking season is in full bloom and I, like many of my Colorado friends, have been out hitting the trails on most weekends. During my last long hike in the Snowmass wilderness with my wife and three close friends, my buddy started talking about how his knees always start to hurt after only a few miles on the trail.  This lead me to think about what can be done to prevent this “normal” occurrence?



The easiest way to reduce force on the knee would be to carry a lighter load. Walking on level ground creates between 2.2-2.5 times your body weight of force with each step. (Taylor, 1998)  Additionally, with a moderate degree of downhill slope, forces can be up to five times greater than walking on level ground. (Roithner, 1998) If we add these forces together, it’s about 10 times your body weight to walk downhill.  Each additional pound you carry ends up being ~10 lbs of force on your knees.  While it is hard to loose body weight, we can reduce the amount in your pack to keep the force on your knees as low as possible.



This should be a no brainer.  If you want to keep your knees happy and healthy, you should spend days off training for the trail.  Look at it this way, if you want to run a marathon, you don’t start by running a marathon. You start with maybe a mile, or 3 minutes, and build up your endurance and tolerance over the course of many weeks.  This same strategy should be utilized in regards to hiking. If you have not walked more than 10 minutes over the last few months, of course you are going to be at risk for injury if you plan a 4 hour round trip hike with elevation. Be wise, progress slowly, and systematically.

Trekking Poles


These can help you hike for a longer duration, on more advanced trails, with less symptoms, because they reduce the load on the knee joints and assist with balance.  If you have difficulty with stepping down stairs, trekking poles could be a huge help.  Research found that trekking poles reduced force on the whole leg, regardless of the amount of weight on the back. (Bohne, 2007).   If you take force away from the knees and add it somewhere else (i.e. the trekking poles) you will have less knee pressure, resulting in less symptoms.

Walking speedsenior-walking.jpg

Ever go hiking with a group of friends on a moderately steep downhill trail?  Are you the person who speeds down the hill, or do you restrain yourself and go slow?  Which is best for that nagging knee pain?  I believe we all have our own appropriate speed that is both efficient and safe for our bodies.  However, research found that force can be lowered by walking slower and with a shorter stride. (Schwameder, 2005) For the avid hiker with some knee pain, reducing your speed and/or stride length should help decrease your symptoms.

In Summary, you have the ability to reduce your nagging knee pain with the above mentioned strategies.  We can reduce overall load,  train wiser, use trekking poles, slow descending speed, and reduce stride length,  While this is not an exhaustive list, these can be a huge help with keeping you feeling great out on the trail.  If this is not enough, or if you have more questions, please feel free to comment below or give me a call at Altitude Physical Therapy (303)-781-3456.  I would be happy to evaluate any area you are concerned with in order to keep you doing what you love.

As always,

Stay healthy and Active!

-Joel Fredrickson, PT, DPT


  1. Bohne M, Abendroth-Smith J. Effects of hiking downhill using trekking poles while carrying external loads.  Med Sci Sports Exerc. 2007; 39(1):177-83
  2. Schwameder H, Lindenhofer E, Muller E.  Efs of walking speed on lower extremity joint loading in graded ramp walking.  Sports Biomech. 2005; 4(2):227-43
  3. Taylor J, Perry J, Cannon S.  The forces in the distal femur and the knee during walking and other activities measured by telemetry.  J Arth. 1998; 13(4): 428-437
  4. Roithner R, Schwameder H, Muller E, et al.  Comparison of the knee joint forces during downhill walking with and without hiking poles.  Institute of Sports Science. 1998; 13: 1-9

3 Simple Ways to Help Stay Injury Free with Yard Work

hardyardwork Yard work season is in full swing here in Denver and if you are like me, you have been sucked in to the frenzy.  Since this is a known cause of injury, I thought it would be best to cover some recommended tips in order to keep you gardening all summer long.

Warm up


This is the “golden rule” for all activity.  Before you spend hours making your yard perfect, spend 10-15 minutes going on an easy walk.  This will improve blood flow and provide you with a safe way to start your yard work off just right.  


Work on your body mechanics


Ever heard the old saying, “lift with your knees, not your back.”  While this may not be true 100% of the time, keeping your back happy and healthy will allow you to be in the garden this season instead of in the clinic due to an injury. Simple recommendations to follow include: keep objects (especially heavy ones!) close to your body; do NOT “lift and twist;” squat and lift objects instead of lifting with a rounded back.  

While these are simple things to remember, I cannot tell you the amount of times I have seen someone in the clinic due to forgetting them.   

Rest breaks are good!

Are you one of those people who thinks 3 hours of back bending gardening is normal? 

rest break

 If so I have news for you, it isn‘t.  Your body needs rest from the position you maintain while performing your yard work.  While this can come in the form of a few back bends every half hour or so, it may even be better to rotate your chores as you complete them.  What I mean is, spend 15 minutes in the garden, 10 minutes raking, and 5 minutes spreading mulch.  Then your body gets a rest from the same position for prolonged periods of time, and you get to work on that long list of projects you want to complete!  

Just remember, taking an actual rest break, where you rest your body and rehydrate, is still necessary.  


As always, stay healthy and active.  While these general guidelines are great for most of the injury free population, it is still wise to get evaluated by your local physical therapist if you are dealing with limitations, pain, or previous injuries.  If this sounds like you, give me a call over at Altitude Physical Therapy, 303-781-3456. 



What can you expect with Physical Therapy?

This is something that I talk about every day in the clinic.  The more you, the patient, understands my expectations, the faster you can recover.  Therefore, I figured it would be good to cover the basics via my blog in order for individuals to refer back to when they have questions about what they are experiencing during their rehabilitation.

Expect to be pushed/challenged

Everyone loves going to a place where you just lay on the table for your allotted time while you get all the “feel good” treatments.  While this may be enjoyable, usually the progress you feel is short lived.

Looking for the long term changes, my patients can expect to be challenged during each visit.  While the word challenged can have a negative implication, I say this in the most positive way possible.  Let me explain myself.  As the patient, you are spending valuable time (and often finances) in order to reach a certain goal.  Do to these factors, I want to progress you as fast as possible in order for you to return to your symptom free life.  Most of the time, this quick progress occurs with challenges being given and conquered.  If you are not being pushed, can you really expect to see a change?


Expect to be (a little) sore

I must say this forty times a day in some capacity, ” If adapting your body was easy, everyone would do it.”  My point is, if you are going to Physical Therapy you are looking for something to change or improve.  This is hard.  Think about all those people you know who are wanting to lose weight, run faster, bike further.  None of these are easy tasks, they take focus, motivation, and consistency.

Working with your Physical Therapist can be similar.  A lot of time, the end goal is to improve a certain’s muscle strength.  In order to improve strength, muscles have to be broken down and rebuilt.  This process leads lasting impressions of your therapy visit usually in the form of soreness.  If used carefully, soreness can be a great sign of your body adapting and progressing towards your ultimate goal.

By no means am I saying that you should be sore from the onset of your rehabilitation until you are discharged.  Usually, the soreness should occur within 24-48 hours after your last visit and lasting for 24-48 hours at most.

Challenge for you, next time your therapist creates some muscle soreness, think about all the good things that are occurring inside your body.  🙂

Expect this to take time

While we all love quick fixes (myself included), however, this is usually not what occurs in Physical Therapy.  Pain may last for several visits, weeks, or even months.  Strength gains may be slow (and usually are!).  Functional improvements may stay the same for days on end.  While this is frustrating, usually we can find the small changes that indicate the steady progress towards your goals.

A basic approach to adaptation time is look at how long you have had this condition.  I.E. If you have had knee pain for 1 year, expect progress to be slow at first and may take several months.  Instead of just having an acute flare up of knee pain (with no accident) a week ago, which usually improves much quicker.

Remember, everyone is different, and what may take me several weeks to improve, may only take you a couple of days and vise versa.  Time will tell how much you truly need.  Don’t loose hope, stay focused on the end goal and keep pushing ahead.

Expect Symptoms to fluctuate

If I had a dollar for every time a patient had a large variation in symptoms between 2 appointments, I would be a very rich therapist.  We do our best to control variables and allow tissue healing to occur.  However, life does happen.  Maybe your home exercise program was progressed too quickly, maybe the manual technique was too strong, or maybe all the stars aligned in your rehab life and your thera-band hit the fan. (Physical Therapist joke alert)

Usually, fluctuations occur during the early phases of therapy due to multiple variables creating your symptoms.  Figuring all of them out and addressing them takes time.  Once your plan of care has been dialed in, you can expect the little fluctuations to dissipate.  However, large flare ups can and do occur during all parts of the therapy process.  If they do occur, don’t look at it as a failure, just as a learning experience that can help your Therapist manage your case better in the future.

Expect to (eventually) be done with Physical Therapy  

This is the day most patients look for, discharge day.  Therapy is designed to have an end day in mind in 99% of all patients.  The reason is that we are looking for you to have independent management of your symptoms.  This along with careful reinstatement of your desired activities in life is the majority of what leads me to when you will be done with therapy.

While these expectations may be something you already know, I hope they helped your understanding of Physical Therapy and why we do certain things.  Everything I do is always in the patient’s best interests.  If you have any questions or comments about this post, please feel free to contact me.

As always,

Stay Active!


What is Physical Therapy?

I figured starting with what Physical Therapy is, and more importantly, what it can do for you, would be an excellent “real” intro to this blog.

Lets start with the first question of the above statement.  Physical therapy is the combination of hands on manual techniques painstakingly perfected (usually the favorite intervention choice of patients) in combination with active movement in order to facilitate a quicker recovery with whatever complaint the patient brings to the clinic. We, being Physical Therapists, work on musculoskeletal and neurologic disorders/disfunction’s in order to keep you, the patient, in a higher quality, pain free, active life.

Ok, thats alot of medical jargon that may or may not make sense to you.  Let me break it down further.  Physical therapy is there for those painful areas that are keeping you from doing the things you love.


The back pain that is limited your running ability.

The shoulder pain that makes you worried about playing another racquetball game.

The ankle pain that occurred just seconds ago when you were reading this blog and tripped off the side walk.  (hopefully no one was hurt in the reading of this blog)

Don’t worry, we are not limited to those 3 areas. We can see you for an extensive array of complaints, from the common complaint of back pain, to dizziness, and on the other end of the spectrum, neurologic disorders as variable as multiple sclerosis.  In fact, it would be easier for me to list the things we do not see, than to list the things we do, because we can and do see so many different complaints.

When you come into the clinic for your appointment, we use our extensive knowledge of the human body with hands on techniques and spectacular ability to segment individual joints when needed with active movement in order to speed recovery and reduce symptoms for the LONG term.  While this may take several weeks to months to achieve, the short term focus helps with the long term goal of having that quality of life you want.

Our job is to listen to your complaint, evaluate the painful/functionally limited area, and develop an individualized plan in order to progress you back to the activities you love.

Now you may be thinking, Joel, I have pain, but I am not an active person.  And the truth is that we can help you as well.  While the research is clear about the negative consequences of inactivity, we can still have a profound impact on your complaint and allow you to return to a pain free life.  While I cannot say that everyone who graduates from physical therapy will never have pain again (or that they all leave 100% pain free). What you should gain from Physical Therapy is a better understanding of YOUR body and how to be independent with your unique senario.

Feel free to contact me with questions through this blog, give us a call or schedule a one-on-one evaluation over at Altitude Physical Therapy.

Staty Active,



Why start a blog?


Thanks for visiting my blog.  Why start a blog in a blog filled world?

Simply…to improve knowledge of the body, impairments that can occur, and what you as the reader can do in order to continue to enjoy the activities you love without pain.

This is my first blog, so we will see how things go.

Looking forward to providing more content soon!

Stay active!