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Treatment for Vertebral Compression Fracture

3 Nov

While there are many potential causes of low back pain in older adults, one of the most common—especially among women—is vertebral compression fracture (VCF). By age 80, up to 30% of women and 20% of men will have sustained at least one VCF. Interestingly, only about one-third of cases produce acute, noticeable pain. The remainder are either asymptomatic or go undiagnosed due to lack of imaging or because other pain-generating conditions such as osteoarthritis or spinal stenosis may mask the fracture. The type of treatment to address the injury depends largely on whether the fracture is stable or unstable.

A vertebral compression fracture occurs when the bony structure of the vertebra collapses, often due to osteoporosis and weakened bone health. If the fracture extends beyond the anterior portion of the vertebra, radically alters spinal alignment, or places pressure on neural structures, it is considered unstable. These cases usually require surgical intervention, such as vertebroplasty or kyphoplasty (injecting a cement-like material into the vertebra) or spinal fusion to stabilize the spine. Fortunately, only 10–15% of vertebral compression fractures are unstable.

Most VCFs are stable and can be managed conservatively, which may include chiropractic care. Treatment guidelines recommend activity modification during the early healing phase—avoiding heavy lifting, twisting, or prolonged sitting or standing. However, patients are encouraged to remain active within pain tolerance, as inactivity can lead to deconditioning and slower recovery. Bracing may be considered on a case-by-case basis, though evidence for its effectiveness is mixed. Spinal manipulation is generally contraindicated, but chiropractors can employ low-force manual therapies, modalities for pain and muscle spasm (such as ultrasound, TENS, or cold laser), and prescribe posture and core stabilization exercises. Co-management with a medical physician may include short-term medications to control acute pain.

Ultimately, the most effective treatment is prevention. Osteoporosis—the most common underlying cause of VCFs—is often silent until a fracture occurs. Guidelines recommend that all women over age 65 undergo a bone density (DEXA) scan, with earlier screening for those with family history or risk factors. While there is no consensus for men, approximately 1 in 6 will develop osteoporosis in old age. Just as important is adopting a healthy lifestyle that includes a nutrient-dense diet, weight-bearing exercise, maintaining adequate vitamin D levels, not smoking, and avoiding excessive alcohol consumption.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Understanding Lumbar Disk Injuries

2 Oct

Low back pain can arise from a variety of structures in the lower back. When symptoms include pain, tingling, numbness, and/or burning that radiates into the buttock, thigh, calf, or foot, a potential cause may be injury to one or more intervertebral disks. These disks function to stabilize the lumbar spine, absorb forces, and facilitate its range of motion.

The lower back is comprised of five lumbar vertebrae separated by intervertebral disks positioned in the anterior portion of the spinal column. The nucleus pulposus is a gel-like structure in the center of the disk that provides much of the strength and flexibility of the spine. In young, healthy disks, the nucleus pulposus is composed of 66–86% water, with the remainder consisting mostly of type II collagen and proteoglycans. The annulus fibrosis, surrounding this core, is made up of concentric layers (lamellae) of fibrous connective tissue, each oriented at about 60 degrees to the adjacent layer. This crisscross radial-ply design provides significant strength and helps prevent leakage of the nucleus pulposus, much like the reinforcement of a radial car tire. Finally, each disk is anchored to the vertebrae above and below by cartilaginous endplates.

Common disk injuries include disk bulge (the annulus remains intact but the disk extends beyond its normal boundaries), disk herniation (the nucleus pulposus pushes through the annulus), disk tear (the annulus itself tears), disk endplate injury (the nucleus pulposus intrudes into the vertebral endplate), disk degeneration (progressive breakdown leading to loss of disk height). Less common conditions include infection or neoplastic (tumor) invasion of the disk space. Importantly, disk injuries are not always symptomatic, which is why guidelines often recommend against advanced imaging for uncomplicated low back pain, as an observed disk herniation may not necessarily explain the patient’s symptoms.

Several studies have shown that it is nearly impossible to herniate a truly healthy disk. Rather, when an apparent injury follows a perceived trauma such as lifting with poor posture, it usually represents the culmination of a longer degenerative process in which the disk ultimately places pressure on a nerve root. Long-term risk factors for disk degeneration include obesity, family history of disk disease, and physically demanding occupations or leisure activities.

The good news is that many disk injuries can be managed non-surgically in a chiropractic setting using a multimodal approach. This may include spinal manipulation and other manual therapies, therapeutic exercise, physiotherapy modalities, and adjunctive anti-inflammatory strategies such as cryotherapy, dietary modification, and supplementation. In the short term, treatment focuses on restoring normal motion around the disk and reducing nerve root irritation. Over the longer term, the goal is to stabilize the spine and correct biomechanical issues that may place excess stress on the disk. If symptoms do not respond adequately, referral to a specialist for more invasive interventions, including surgical options, may be warranted.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Monthly update on Lower Back Pain

14 Jul

Chiropractic Treatment for Lumbar Spinal Stenosis

            Lumbar spinal stenosis is a condition caused by the narrowing of spaces within the lower spine, which can compress either the spinal cord or nerve roots. This pressure can lead to pain, numbness, or weakness—either locally or radiating down the legs—especially during activities that involve spinal extension (e.g., bending backward or prolonged standing) or compressive loading. While stenosis may result from trauma, congenital anomalies, or systemic diseases, approximately 80% of lumbar spinal stenosis cases are degenerative in origin. Common degenerative contributors include intervertebral disk bulging or herniation, facet joint hypertrophy (arthritis), ligamentum flavum thickening, spondylolisthesis (vertebral slippage), and osteophyte (bone spur) formation. How might chiropractic care help a lumbar spinal stenosis patient both avoid surgical intervention and return to their normal activities to as high a degree as possible?

In the medical model, initial treatment may include physical therapy and/or medications. If those fail to provide relief, a common next step is epidural steroid injections (ESIs), which aim to reduce nerve inflammation and provide temporary symptom relief. A 2025 systematic review of 90 randomized controlled trials found that ESIs can offer short-term improvement in pain and disability but do not result in long-term symptom resolution. If a patient experiences minimal relief after one to two injections, if relief lasts less than one month, or if neurological symptoms progress, further injections are generally not recommended. Clinical guidelines typically limit ESIs to a maximum of three per year, and suggest limiting repeated use to no more than two to three consecutive years due to risks such as bone loss, adrenal suppression, and soft tissue damage.

If the patient pursues chiropractic care, the aim of treatment would be to reduce neural compression by improving lumbar spine mobility and joint spacing. For lumbar spinal stenosis, current guidelines discourage high-velocity, low-amplitude (HVLA) spinal manipulation. Instead, they support gentler techniques such as flexion-distraction, mobilization, and instrument-assisted soft tissue therapies. Chiropractic care may also include targeted exercise, posture training, and neuromuscular re-education to support spinal health and nerve mobility.

Just as critical as in-office treatment is the home management component. Patients are encouraged to perform flexion-based and low-impact exercises—such as stationary biking, inclined treadmill walking, wall sits, and knee-to-chest stretches—which can reduce pressure on lumbar nerves. Core stabilization improves spine support, while posture training and ergonomic adjustments (e.g., lumbar support, avoiding prolonged standing, sleeping with knees elevated) help maintain relief. Lifestyle modifications such as weight loss, an anti-inflammatory diet (rich in omega-3s, vegetables, and whole foods), hydration, and use of ice, heat, or TENS units for pain control can further support long-term improvement.

The good news: with consistent effort, as many as 70% of patients with lumbar spinal stenosis can improve or maintain stable symptoms without ever needing surgery. Only about 30% of patients progress to requiring surgical intervention—typically when pain is disabling, function is severely limited, or neurologic decline occurs.

Watching your back,

Dr. Binder

Pain Relief Chiropractic

painreliefcare.net

(717) 697-1888

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

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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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.

Chiropractic Treatment for Lumbar Disk Herniation

10 Dec

The annulus of the intervertebral disk is comprised of tough, dense, and strong cartilaginous fibers that protect the nucleus within, which facilitates the movement of the spine. If the structure of the annulus is compromised, the nucleus can leak into or beyond the annulus, a condition that may be classified as a disk herniation, protrusion, extrusion, or sequestration. In the event a disk herniation in the lumbar spine places pressure on a lumbar nerve root, an individual may feel pain down into the leg, which is called lumbosacral radiculopathy or sciatica. Absence a red flag—infection, fracture, cancer, and cauda equina syndrome (loss of bowel and/or bladder control)—that may necessitate immediate emergency and/or surgical intervention, what treatment approach may best serve a patient with a newly diagnosed lumbar disk herniation?

In 2022, researchers conducted a retrospective cohort study that looked at outcomes of more than 11,000 patients under age 49 with a newly diagnosed lumbar disk herniation, half of whom received initial treatment from a doctor of chiropractic. While the authors of the study note that additional studies are needed, their analysis revealed that lumbar disk herniation patients whose first choice of treatment is chiropractic care are significantly (up to two-times) less likely to undergo lumbar diskectomy in the following two years than disk patients who initially seek out a different healthcare provider.

It should be noted that treatment guidelines generally advise conservative treatment approaches, which include chiropractic care, before consulting with a surgeon. However, another study published in 2022 found that, among a group of 144 patients who underwent back surgery, 60 (41.7%) did not receive any conservative treatment in the six months before their procedure. A 2021 study that looked at questionnaires completed by 3,724 adults revealed that the majority of respondents believe that surgery is always needed for a disk herniation, which is inaccurate.

For the management of a lumbar disk herniation, doctors of chiropractic will typically employ a multimodal approach that includes spinal manipulative therapy, mobilization therapy, soft tissue therapy, and exercise training. Chiropractors may also offer additional services such as traction or non-surgical decompression that can benefit such patients. If the patient does not experience improvement in their pain and disability or their condition worsens, they may be referred to an allied healthcare provider to explore other treatment options.

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