Low Back Pain: What Can I Do for It?

Back-Pain-PNG-FileLow back pain (LBP) is the second most common reason for doctor visits in the United States and it is a condition that most of us will at some point in our lives. Last month, we reviewed the wide acceptance of spinal manipulation as the treatment of choice for both acute and chronic LBP. This month, let’s take a look at what you can do outside the doctor’s office to self-manage acute and chronic low back pain.

One of the best self-management protocols for LBP is exercise that targets the lower back. It appears that the optimal time to engage in exercises for the lower back is during the work day since doing so may help alleviate some of the overuse and repetitive strain contributing to one’s LBP. Let’s focus on exercises you can perform from either a sitting or standing position during short work breaks…

RULES: Perform slowly to a full/firm stretch without pain; take three slow deep breaths for each; only do exercises that “fit” your job and time limits—this might be only one every fifteen minutes; make it work!

SITTING EXERCISES: 1) Sitting Forward Bends – bend forward and reach for the floor (as far as reasonably tolerated). 2) Sitting trunk rotations – twist slowly left, then right. 3) Cross Leg Stretch – cross one leg over the other; grasp and pull the crossed leg knee to the opposite shoulder while arching the back to its maximum until a firm stretch is felt in the buttocks.

STANDING EXERCISES: 1) Hamstring Stretch – place one foot on an elevated surface (like a chair seat, foot stool, or guard rail); perform an anterior pelvic tilt by arching your low back until you feel a firm stretch in the hamstrings. Switch sides and repeat. 2) Groin Stretch – do exactly the same steps as the hamstring stretch but this time, rotate your trunk to the side of the standing leg (away from the stretched leg) until you feel the stretch in the inner thigh or groin muscles. 3) Backward Bends – place your fists behind your low back and slowly bend backwards to a maximum tolerated point.

These “portable” exercises can be performed frequently throughout the work day, whenever you can spare 30-60 seconds. The most important point is to do these exercises on a regular basis. It may help keep your LBP from worsening during your workday.

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Can Chiropractic Help Prevent a Hamstring Injury?

hamstringSports that require rapid acceleration and deceleration, cutting left and right, agility, jumping, and bending pose a unique risk for injury to the lower limbs. Hamstring injuries are the most prevalent injury in Australian rules football, afflicting 16% of players, causing an average of 3.4 missed matches per injury, accounting for the most time lost due to injury, and having the highest recurrence rate once players return to the active roster. Moreover, a player’s performance can be highly diminished by hamstring injuries.

In a 2010 study, researchers randomly assigned 57 male Australian football players to either a control group that received the current best practice medical and sports science management or an intervention group that received the same care with the addition of a sports chiropractic manual therapy injury prevention program that included manipulation/mobilization and/or soft tissue therapies to the spine and lower extremities. Both groups received a minimum of one treatment per week for six weeks, one treatment every two weeks for three months, and one treatment per month for the remainder of the season (three months).

At the close of the season, the researchers found that the group receiving the chiropractic injury intervention program reported significantly fewer primary lower-limb muscle strains and weeks missed due to no-contact knee injury than the other group. Though lower-limb injury prevention was the primary focus of this study, the players in the chiropractic group also experienced fewer episodes of back pain.

Because dysfunction in one area of the body can place added stress elsewhere, it’s important to examine the whole patient in order to identify other issues that may either be the cause or contribute to the patient’s chief complaint. Likewise, preventative care focused on maintaining proper motion in the joints throughout the body can lead to a reduced risk for injury, as was demonstrated by this study.

What Exercises Are Best for Neck Pain?

Past research has demonstrated that combining spinal manipulative therapy (SMT) with exercise yields the best long-term results for individuals with neck pain. So what neckpain-e1464705188848exercises should we consider when neck pain rears its ugly head?

In the acute phase of an injury, rest and ice may be appropriate, but patients will often benefit from lightly applied isometric exercises. Place your hand against the side of your head and lightly push your head into your hand for a count of five seconds. If tolerated, tip your head sideways five to ten degrees and repeat the process. This can be repeated multiple times at progressively greater angles until you’ve accessed your full range of motion (ROM).

The above isometric exercise can be repeated in the opposite direction as well as forwards, backwards, and into left and right rotation directions. The KEY is to always stay within reasonable pain boundaries—no sharp/”bad” pain allowed!

You can then move on to isotonic neck exercises. Using the same amount of light pressure, gently push your head into your hand as you did before, but this time, allow the head to move slowly toward the shoulder against the pressure of the hand. This too can be repeated on the opposite side, forwards, backwards, and into left and right rotation.

Using only one or two fingers rather than the whole hand helps to prevent you from pushing too hard with your hand or head when performing isometrics or isotonic exercises. Also, the same movements of the head can be done without any hand/finger resistance, but faster results seem to occur when pressure is applied.

Studies also show that weakness of the deep neck flexor muscles is

very common in people with chronic (more than three months) neck pain. These are deep, involuntary muscles, so to properly strengthen them, look straight ahead, tuck in your chin as far as you can, hold for five to ten seconds, and repeat five to ten times.

Beyond treatment options for neck pain such as spinal manipulation, mobilization, and exercise, your doctor of chiropractic may utilize soft tissue therapies such as myofascial release, active release technique, as well as various physical therapy modalities, ergonomic modifications, and more in the effort to help you get out of pain and return to your normal activities.

How Does Chiropractic Help Whiplash Patients?

Whiplash associated disorder (WAD) injuries usually result from rear-end, low-impact crashes with about 90% occurring at speeds less than 14 mph. Approximately 40% of all WAD patients develop long-term, chronic problems. Let’s look at how chiropractic care can help crash-injured patients recover and return to their normal lives…

neck painREDUCE INFLAMMATION: Inflammation occurs when ligaments and muscles are injured. However, the pain associated with inflammation may be delayed and not show up right away. Rather, you may wake up the next morning with acute neck and/or back pain, as WAD injuries are NOT limited to only the neck. Several studies have shown that chiropractic spinal manipulation results in the release of anti-inflammatory Interleukin 6 (IL-6), which helps reduce inflammation.

RESTORE MOVEMENT: Injured joints quickly become stiff from pain and swelling. Muscles often “splint” in response to pain as a way to protect a deeper ligament or joint-related injury. Both factors can lead a patient to unnecessarily restrict their movement, weakening that area of the body, and increasing the risk of further injury down the road.

REDUCE SCAR TISSUE: As injured tissue heals, the body’s “Band-Aid” is actually scar tissue that is made up of similar cells as the surrounding tissue but is laid down quickly and in an unorganized way. Scar tissue reduces the ability for the injured tissue to stretch and can lead to tissue shortening. If it is performed early enough, Chiropractic adjustments help to stretch out and—in a sense—break up the scar tissue.

RELIEVE LOCALIZED PAIN: Many studies report spinal manipulation (SM) to be a safe, fast, and effective way to reduce pain. As a result, SM is now strongly recommended in treatment guidelines published throughout the world.

REDUCE WIDESPREAD PAIN: Some WAD-injured patients develop pain not just in the neck or back but more widespread throughout their body. This is thought to be caused by “sensitization” of parts of our nervous system. Spinal adjustments have been shown to stimulate the nervous system in such a way as to reduce this hypersensitized effect.

REDUCE STRESS & CHRONIC PAIN: Due to initial high pain intensity, stress and anxiety levels often soar following a WAD injury. Chiropractic care includes patient education, exercise, nutrition, and more to help patients cope with ongoing problems. The importance of  cannot be overemphasized in quest of preventing chronic, long-term pain and disability.

Low Back Pain: Spinal Manipulation vs. NSAIDs

lbpLow back pain (LBP) is the single greatest cause of disability worldwide and the second most common reason for doctor visits. Overall, LBP costs society more than $100 billion annually when factoring in lost wages, reduced productivity, and legal and insurance overhead expenses.

Studies regarding the use of spinal manipulation(SM)—a form of treatment offered by doctors of chiropractic—for LBP are plentiful and have led to the strong recommendation that SM should be considered as a FIRST course of care for LBP. The American College of Physicians and the American Pain Society both recommend SM for patients with LBP who don’t improve with self-care.

In 2010, the Agency for Healthcare Research and Quality (AHRQ) reported that SM is an effective treatment option for LBP – EQUALLY effective as medication in reducing LBP and neck pain.

A 2013 study compared SM and non-steroidal anti-inflammatory drugs (NSAIDs) and found that SM was MORE effective than diclofenac, a commonly prescribed NSAID, for the treatment of LBP. Patients in the SM group also reported NO adverse side effects. More importantly, a 2015 study found that NSAID use can actually slow the healing process and even accelerate osteoarthritis and joint deterioration!

Doctors of chiropractic utilize SM on many conditions, including LBP— more than any other healthcare profession including osteopathy, physical therapy, medical doctors, and others. Chiropractors also combine other synergistic forms of care, such as patient-specific exercise training, to help patients learn how to self-manage their LBP, as recurrence is such a common issue.

The Many Functions of Your Nervous System

Every movement, smell, taste, touch, sound, thought, and dream has its origin in the nervous system.

Every function of your body, both voluntarily and involuntarily is controlled, at least in part, by your nervous system.

To better understand how the nervous system works, it is necessary to discuss what makes up the nervous system.

The Nervous system is made up of two primary systems: the central nervous systemlabeled-nervous-system-diagram-nervous-system-diagram-labeled-central-nervous-system-diagram and the peripheral nervous system.

The central nervous system (CNS) is made of the brain and spinal cord, while the peripheral nervous system (PNS) is comprised of nerves such as those in our arms, legs, and torso that deliver information back to the CNS for processing.

Many of the functions of the PNS are voluntary—that is, we can control actions like reaching for plate, swinging a golf club, or swimming.

Other actions are involuntary like the beating of the heart, breathing rates during exercise, digesting food, regulating our blood sugar, metabolism, and so on.

Many of the automatic involuntary functions are controlled by a subcategory of the PNS called the autonomic nervous system (ANS) which has two components: the sympathetic and parasympathetic nervous systems.

There is always activity in the sympathetic nervous system operating at a basal level called “sympathetic tone” and its activity increases at times of stress (producing a “fight-or-flight” response).

The parasympathetic nervous system basically does the opposite of the sympathetic nervous system.

When the heart rate increases (sympathetic response), the parasympathetic nervous system slows it down. Just as the “fight-or-flight” response relates to the sympathetic NS, a “rest and digest” function describes the parasympathetic NS.

Hence, the autonomic nervous system (ANS) is made up of nerves that innervate cardiac muscle, smooth muscle, and glandular tissue.

From a functional perspective, think of the nervous system as a highway with information being transmitted to and from different locations in the body.

The roads or pathways bring information to the CNS (brain/spinal cord) and are called sensory nerves (afferent).

Consider what happens when you touch a hot stove…

In this example, your hand is quickly pulled away from the stove. To accomplish this, there are nerve fibers that connect or bridge between the afferent (sensory) and efferent (motor) nerves called interneurons.

To break this down even further, under a microscope, the space or junction between two neurons/nerves is called a synapse, which is a very narrow gap where chemicals called neurotransmitters allow an impulse to pass through the gap so an impulse can travel onto another “road” (nerve) to bring information to and from the CNS. Therefore, each synapse is like a ferry boat (chemicals) carrying a car (the impulse) across the gap to the next road in route to the brain and/or spinal cord. This gets further complicated as there are many different chemicals (“ferry boats”) called neurotransmitters that result in different types of responses. These responses are broadly classified into either those that excite or inhibit and result in an action that is incredibly fast, which is often needed to avoid injury or death. The example of touching the stove clearly describes the quick reaction that results from the combined chemical and electrical signaling that takes place. If these chemicals get out of balance, different reactions can occur and many of the medications used in treating depression, bipolar disorder, schizophrenia and other psychological conditions exert their effects directly on these neurotransmitters (such as serotonin).

So as you can see, the nervous system is very complex and yet, very balanced allowing us to function and perform in an automatic, coordinated way, so that most of the time, we don’t have to think about what we are doing to a point of exhaustion.

Many things can negatively affect the functions of the nervous system such as trauma/injury, lack of sleep, stress, chemical abuse (alcohol, cocaine, heroin, etc.), and diet.

Chiropractic focuses much attention on balancing these functions through manipulation of the spine, which has both local and more distant effects through “somatovisceral” and “somatic” responses, thus affecting both voluntary and involuntary functions.

Management of sleep, stress, diet, exercise, and other aspects of life are important in maintaining a healthy lifestyle and quality of life.

Much of this information was obtained from the following URL (check it out!): http://en.wikipedia.org/wiki/Nervous_system#Nervous_system_in_humans. This site includes many pictures of the CNS and PNS as well as a description of all the components that make up the nervous system.

Can Chiropractic Prevent Some Types of Arthritis?

This question is asked frequently by patients visiting chiropractors.article-009-arthritis

To answer this question, let’s first talk about, “what is arthritis?”

The word “arthritis” is derived from “arth-” meaning “joint” and “-itis” meaning “inflammation.”

Hence, arthritis is basically swelling in the joint.

Many types of arthritis have been identified—in fact, over 100!

Some types of arthritis are primary (not caused by anything that can be identified), while others are secondary to a disease or other condition.

The nine most common primary forms of arthritis are: osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, juvenile idiopathic arthritis, Still’s disease, and ankylosing spondylitis.

The most common type that virtually affects everyone sooner or later is osteoarthritis. This is basically the wearing out of the joint, which usually seen in the older person but can be found at any age after trauma or injury occurred or after an infection in the joint.

The next most common is rheumatoid arthritis, which is an autoimmune disease where the person’s antibodies attack the joint (and possibly other tissues as well). This can occur at a young, middle, or older age whenever the body is triggered to produce the joint attacking antibodies. Crystals deposited in joints can injury the cartilage surface of which the most common is gout—often attacking the base joint of the big toe, and pseudogout.

SO NOW THE QUESTION…
CAN CHIROPRACTIC PREVENT
SOME FORMS OF ARTHRITIS?

The answer is yes…. sometimes. For example, when a spinal joint is fixated, stuck, or subluxated, the normal biomechanics of the spine are altered because of the faulty movement between the vertebrae.

Restoring movement can restore proper function so excess forces are not exerted on the adjacent levels.

A good example of this is when 2 or 3 vertebrae are fused together (surgical or congenital), the levels above and below the fusion have to work harder for the spine to move and function and tend to become osteoarthritic sooner than the other non-fused levels.

From a more broad approach, lifestyle changes including exercise, weight management, the use of a brace or splint, and certain medications and dietary supplements can be helpful as well.

Exercise, in particular, can have significant benefits to the joint surface in both pain relief and slowing down or even stopping the degenerative process (osteoarthritis).

Diet emphasizing an anti-inflammatory approach includes the paleodiet or caveman diet where grains/glutens are avoided and lean meats, fruits, and vegetables are emphasized (see http://www.paleodiet.com/ and http://www.deflame.com/).