Low Back Pain and The Importance of Sleep

27 Feb

Monthly Health Update: Whole Body

Low back pain is the leading cause of disability worldwide, and it’s estimated 619 million people suffer an episode each year. By 2050, it’s expected this total will jump to 843 million! In addition to the direct and indirect effects low back pain can have on the individual patient, the overall healthcare costs and productivity losses associated with this musculoskeletal disorder add up to more than $230 billion dollars each year in just the United States! This in mind, identifying and mitigating risk factors for low back pain by even a small amount can result in large societal gains. One risk factor for low back pain that isn’t typically imagined is sleep.

Sleep is considered essential for survival. Many vital functions occur during slumber including tissue growth and repair, cytokines production to bolster the immune system, heart rate and blood pressure regulation, memory consolidation, and brain detoxification, just to name a few. If an individual suffers from insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, or sleep bruxism, these critical processes are impeded, which can make the body more susceptible to developing musculoskeletal pain, including low back pain.

In one study, researchers looked at health data concerning 6,285 older adults and found that an individual’s risk for low back pain increases by 13.6% for each hour less than seven hours of sleep he or she averages a night. However, any additional sleep beyond seven hours does not confer additional low back pain reduction benefits. Interestingly, this finding held true even after adjusting for age, gender, income level, education level, and occupation.

Not only can poor sleep increase the risk for low back pain, but it can stimulate changes in how pain is perceived, leading to greater pain sensitivity, which in turn results in increased disability and avoidance behaviors. One study, published in December 2020, found that older adults with moderate-to-severe sleep disturbances will likely accumulate chronic neuropsychiatric and musculoskeletal conditions at a faster rate than seniors with good sleep hygiene. To complicate matters, the American Academy of Sleep Medicine reports that 80% of American adults experience daytime sleepiness, meaning they either aren’t sleeping enough each night or the quality of their sleep is poor. So what can be done to improve sleep hygiene?

The Centers for Disease Control and Prevention (CDC) offers the following tips for better sleep: be consistent with bed times; make sure your bedroom is quiet, dark, relaxing, and kept at a comfortable temperature; remove electronic devices from the bedroom; avoid large meals, caffeine, and alcohol before going to bed; and get some exercise during the day. If low back pain is keeping you up at night, be sure to let your doctor of chiropractic know. They may be able to recommend additional strategies to improve your sleep and if necessary, co-manage your case with an allied healthcare provider.

If you are struggling with sleep, come on in for a visit!

Watching your back,

Dr. B

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

 717-697-1888

Painreliefcare.net

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Low Back Pain and The Importance of Sleep

6 Feb

Low back pain is the leading cause of disability worldwide, and it’s estimated 619 million
people suffer an episode each year. By 2050, it’s expected this total will jump to 843 million! In
addition to the direct and indirect effects low back pain can have on the individual patient, the overall
healthcare costs and productivity losses associated with this musculoskeletal disorder add up to more
than $230 billion dollars each year in just the United States! This in mind, identifying and mitigating
risk factors for low back pain by even a small amount can result in large societal gains. One risk
factor for low back pain that isn’t typically imagined is sleep.

Sleep is considered essential for survival. Many vital functions occur during slumber
including tissue growth and repair, cytokines production to bolster the immune system, heart rate and
blood pressure regulation, memory consolidation, and brain detoxification, just to name a few. If an
individual suffers from insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, or
sleep bruxism, these critical processes are impeded, which can make the body more susceptible to
developing musculoskeletal pain, including low back pain.

In one study, researchers looked at health data concerning 6,285 older adults and found that
an individual’s risk for low back pain increases by 13.6% for each hour less than seven hours of sleep
he or she averages a night. However, any additional sleep beyond seven hours does not confer
additional low back pain reduction benefits. Interestingly, this finding held true even after adjusting
for age, gender, income level, education level, and occupation.

Not only can poor sleep increase the risk for low back pain, but it can stimulate changes in
how pain is perceived, leading to greater pain sensitivity, which in turn results in increased disability
and avoidance behaviors. One study, published in December 2020, found that older adults with
moderate-to-severe sleep disturbances will likely accumulate chronic neuropsychiatric and
musculoskeletal conditions at a faster rate than seniors with good sleep hygiene. To complicate
matters, the American Academy of Sleep Medicine reports that 80% of American adults experience
daytime sleepiness, meaning they either aren’t sleeping enough each night or the quality of their
sleep is poor. So what can be done to improve sleep hygiene?

The Centers for Disease Control and Prevention (CDC) offers the following tips for better
sleep: be consistent with bed times; make sure your bedroom is quiet, dark, relaxing, and kept at a
comfortable temperature; remove electronic devices from the bedroom; avoid large meals, caffeine,
and alcohol before going to bed; and get some exercise during the day. If low back pain is keeping
you up at night, be sure to let your doctor of chiropractic know. They may be able to recommend
additional strategies to improve your sleep and if necessary, co-manage your case with an allied
healthcare provider.

Watching your back,

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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Glute Weakness & Low Back Pain

30 Jan

Glute Weakness and Low Back Pain

While we traditionally view low back pain as the result of a problem localized to the low back itself, several studies have found that issues in adjacent parts of the body can play a role in the development of low back pain.  For example, chronically tight hamstrings can affect pelvic tilt, which in turn can alter the posture of the lumbar spine, potentially leading to low back pain. Another potential contributor to low back pain that’s often overlooked is glute muscle weakness.

In September 2024, the New York Times ran an article focused on a condition called gluteal amnesia, though it’s more colloquial name is dead butt syndrome. Gluteal amnesia is the result of prolonged inactivity of the three glute muscles (maximus, medius, and minimus). Prolonged inactivity can occur from things such as sitting at a desk or in a car for more than two to three hours at a time without getting up to move around and stretch. The gluteals help stabilize the hip, lift the leg, and rotate the thigh. This muscle group also serves an important role in the kinetic chain, and when not working properly, the risk for problems like hamstring tears, sciatica, shin splints, and knee arthritis increases.

Gluteal amnesia is NOT like the temporary numbness/tingling noticed when we sleep on an arm and it “falls asleep” or goes numb and recovers quickly when we change positions. Some people may feel a dull ache or pain after a long walk or after a jog or hike. Because muscle strength and activation are affected, the body may recruit nearby muscles to help perform regular movements, which can lead to pain in the lower back, for example.

            Though it’s best to be examined by a qualified healthcare provider, like a doctor of chiropractic, you can perform the following test to check if you may have dead butt syndrome: stand on one leg letting the other leg dangle (standing sideways on a step holding onto a railing works well) press into your buttocks region on the dangling leg, it should feel soft (not firing); do the same on the other side; now stand on both feet and squeeze your “cheeks” hard; you should feel the muscle contract or get firm; if it takes a few squeezes before you feel it get firm, then you may have gluteal amnesia.

            The key to overcoming this condition is to restore normal activation to the gluteal muscles. You can start by setting an alarm on your phone to stand up every 30-50 minutes and gently tap on your glut/butt cheeks with your fingertips. This reminds the brain that these muscles need to fire. Better yet, march in place, do some hip circles and squats and consciously tighten your gluts with each rep. Other exercises for this include clamshells, hip thrusts, side planks, split squats, and single-leg glut bridges. Just remember to consciously engage the glutes.

            If the condition persists, schedule an appointment with your doctor of chiropractic so they can determine if there are additional problems present that can be addressed with treatments provided in the office, such as manipulative or mobilization therapy, with the goal of helping restore normal function.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

717-697-1888

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Shoulder and Elbow Injuries in Baseball Players

8 Sep

Overuse injuries in baseball—particularly in the shoulder and elbow—are a significant problem at both amateur and professional levels. Studies have shown that shoulder pain is one of the most common complaints among amateur baseball players, with a prevalence ranging from 13.4% to 20.6% of players. Elbow injuries are also very common and affect from about a fifth to a quarter of all players, with youth players at greater risk. While all position players can develop upper-extremity injuries, these injuries tend to occur more frequently and severely in the dominant arm of pitchers.

Despite advancements in medical management and increased knowledge about preventive care, the rates of shoulder and elbow injuries in baseball players are on the rise. The consequences of these injuries can be significant, leading to time lost from the sport, reduced performance, the need for surgical interventions, and giving up the sport entirely.

Researchers have identified several potential risk factors for shoulder and elbow injuries in baseball players including increased mechanical load (measured by pitch count or training hours), higher pitching velocity, and decreased shoulder range of motion (ROM), particularly in flexion, internal rotation, and horizontal adduction. While the perceived stress of throwing curve balls is thought to increase the risk for arm injury, it’s not currently demonstrated in the data that this is the case. There’s limited evidence that weakness of the shoulder abductors and external rotators can contribute to shoulder pain, as can scapular dysfunction. Despite the clinical emphasis on the role of lower limb and trunk function in injury prevention and rehabilitation, there isn’t much research to support this strategy.

A study that included 60 active young adult baseball players may have uncovered a strategy for preventing upper extremity injuries. In the study, researchers assigned half the players to a stretching group and the other half to a stretching plus manual therapy group with the goal of addressing range of motion deficits between their dominant and non-dominant sides. After a single treatment session, both groups demonstrated improved range of motion (internal rotation, total arc of motion, and horizontal adduction), but the stretching plus manual therapy group experienced greater improvement. Because the loss of motion is a known risk factor for arm-related injuries, the authors reported that this combined approach should be used to prevent future injury.

Chiropractors utilize manual therapies more than any other healthcare profession with goal of breaking up scar tissue and adhesions, promoting circulation to the region to facilitate healing and strengthening of muscles and tendons, and restore normal motion to affected joints.

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Jaw Pain and Neck Pain Connection

7 Sep

Temporomandibular disorders (TMDs) are a common condition characterized by pain and discomfort while chewing. Traditionally, when patients complain of jaw pain, the focus has been on structures like the temporomandibular joint or the masseter muscles. However, there’s a growing body of research suggesting the intimate relationship between the jaw and the neck may be a contributing factor or even the underling cause of a patient’s TMD.

In one study, which included 40 women between 19 and 49 years of age, half of whom had chronic TMD, researchers observed that participants with jaw pain and discomfort were more likely to have neck pain and stiffness that limited their daily activities. Additionally, among the TMD patients, the more jaw muscle tenderness they exhibited, the higher their scores for both TMD- and neck-related disability. The research team observed a similar relationship between tenderness in the upper trapezius (the muscles in the shoulder and neck regions) as well as the temporalis muscles that function to close the jaw, located on the side of the head above the ear extending to the temporomandibular joint. The authors concluded that a significant correlation between neck disability and jaw disability exists and that healthcare providers should consider the neck and its related structures during the evaluation and management of patients with TMD.

These findings are echoed in a July 2022 study that found TMD patients with restricted cervical range of motion experience more severe TMD-related pain and disability than TMD patients with normal cervical range of motion. Another study published the same month found that patients with chronic (lasting longer than three months) TMD were two times more likely to have neck pain than individuals with acute (less than three months) TMD. A study published later that year linked neck pain with increased sensitivity of the masticatory muscles in TMD patients, leading the author to conclude, “In TMD treatment, we should pay attention to and actively relieve neck pain.”

In a study published in October 2021, researchers found that patients with concurrent neck pain and TMD experienced improvements in jaw function following care targeting the cervical spine. A systematic review conducted in 2023 confirmed these findings. The authors cited five studies that supported the application of manual therapies to restore normal movement to the cervical joints can improve pain, pain sensitivity, and function in the jaw. Interestingly, a systematic review published in March 2024 concluded that cervical rehabilitation interventions—such as manual therapies combined with neck-specific exercises—are effective for reducing pain intensity associated with myogenic temporomandibular disorders, which is TMD specifically linked to pain originating in the jaw muscles.

The good news is that doctors of chiropractic are well-versed in managing patients with neck pain as well as TMD using manual therapies and specific exercises to address trigger points in the jaw and neck muscles, as well as to restore normal motion to the temporomandibular joint and cervical spine.

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Aquatic Exercise for Low Back Pain

7 Sep

Deconditioned and tight muscles are often observed in patients with chronic low back pain and must be addressed for the patient to achieve a satisfactory outcome. Research on physical activity to manage chronic low back pain typically involves land-based exercises— like brisk walks or cycling, for example—but what about aquatic exercises? Do water-based exercises have a place in chronic back pain management?

In January 2024, researchers conducted a systematic review and meta-analysis that included data concerning 524 chronic low back pain patients from 15 studies who participated in either water- or land-based exercise intervention, or they had been assigned to a waiting list to serve as a non-active control group. Their analysis revealed that participants in both exercise groups experienced significant improvements in pain intensity when compared with the non-active patients. Those in the water- and land-based groups also reported similar improvements with respect to low back pain-related disability and flexibility that were not evident in the control group. Ultimately, the authors concluded that aquatic exercise is as effective as land-based options for managing chronic low back pain.

For those who find land-based exercises challenging—especially if weight-bearing exercises are too stressful on the joints—aquatic exercise may be a viable option. However, water-based exercise is not just a synonym for swimming laps. There are several forms of water-based exercise available, such as water aerobics, aqua jogging, water walking, aqua Zumba, water yoga, water polo, aqua cycling, pool volleyball, resistance band training, and water tai chi. These various workouts take advantage of buoyancy so there’s less impact on joints, the natural resistance of water for strength training, and the cool-down effect of water on the skin. For individuals who get more enjoyment from group workouts, these exercises are an excellent choice!

In addition to helping manage chronic low back pain, meeting physical fitness guidelines of 150 minutes of moderate- or 75 minutes of vigorous-intensity exercise each week may also reduce the risk for developing chronic low back pain in the first place. Furthermore, patients who recover from chronic low back pain and stay physically active are also less likely to experience a recurring episode. So if traditional exercise like jogging or cycling doesn’t appeal to you and you’d rather spend time in the pool, consider an aquatic exercise routine!

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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