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Management Strategies for Chronic Low Back Pain

2 Oct

Chronic LBP (cLBP) is a BIG problem in our society, accounting for about 33% of work-related disability. So, what is the best management strategy for cLBP?

One study looked at the effectiveness of spinal manipulation therapy (SMT) using three groups of patients with cLBP. Each group received either: 1) “sham” spinal manipulation (twelve treatments of sham or “fake” SMT) over a one-month timeframe and then discontinued; 2) “real” SMT (high-velocity, low-amplitude thrust) twelve times during a one-month timeframe and then discontinued; and 3) the SAME as the second group but with additional SMT treatments every other week for nine additional months.

As expected, the first group saw no benefits from sham SMT with the second and third groups reporting similar benefits after one month of care. However, ONLY the third group reported continued benefits at the tenth month. The study concluded that in order to obtain long-term benefits for patients with cLBP, patients should receive maintenance care after an initial intensive care plan. It’s also worth noting that this 2011 study was not only published in the illustrious journal SPINE but it was authored by two medical doctors.

More recent studies have consistently validated that SMT is a safe, effective method of managing cLBP, especially when it is repeated on a maintenance basis.

Doctors of chiropractic also include exercise training for flexibility and core strengthening as standard recommendations in the management of LBP patients, in addition to advice to remain active and avoid prolonged bed rest. If you haven’t utilized chiropractic care for cLBP, you owe it to yourself to give it a chance – the evidence supports it!

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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Pregnancy and Low Back Pain – Part 3

4 Sep

In Part 1 of this series, we discussed the many aspects of pregnancy that contribute to low back pain (LBP) including hormonal, chemical, biomechanical, and psychological changes that occur throughout pregnancy. In Part 2, we looked at the results of several studies showing that chiropractic care can help reduce low back pain (LBP) both during pregnancy as well as during labor and delivery. This month, let’s focus on what to expect when you visit a doctor of chiropractic.

The initial visit typically consists of an intake process: a history, examination, vital signs, and so on. Your doctor of chiropractic will discuss the treatment goals and procedures typically utilized during the three trimesters of pregnancy and will provide a treatment recommendation.

After the initial treatment, it is not uncommon for people, pregnant or not, to feel a “post-exercise soreness” type of discomfort. This makes sense as chiropractic adjustments and mobilization are indeed “exercising” your spinal joints with the goal of reducing joint stiffness and fixations, which some chiropractors may refer to as “spinal joint subluxations.”

There are many types of manual therapies available, and finding the method that matches your choice and needs is important. One type of manipulation often associated with chiropractic includes the use of a “high-velocity, low-amplitude” (HVLA) thrust, which is frequently referred to as “an adjustment.” Joint cavitation or the “cracking” sound that commonly occurs with adjustments is created by the formation of a gas cavity within the spinal joint space during the maneuver. The spinal joints often become looser during pregnancy due to the increase in circulating progesterone, estrogen, and relaxin, especially in the third trimester. Typically, very little force is needed to successfully cavitate a spinal joint when utilizing HVLA adjustments. For some patients, the cracking sound can provoke anxiety and in those cases, low-velocity, low-amplitude techniques may be preferred, as this does not typically result in joint cavitation.

Exercise throughout pregnancy is important, as studies show it improves energy, reduces mood swings, facilitates in stress management, and results in more restful sleep. Other benefits include less weight gain during pregnancy (by approximately 21%); shorter and easier labor (decreased by an average of two hours); fewer medical interventions experienced (24% fewer cesarean deliveries and 14% reduction of forceps use); less fetal distress; and faster recovery times.

Nutritional counseling is also appreciated and very important during pregnancy, and chiropractors are well-trained in this form of management.

Doctors of Chiropractic can work with OB/GYN doctors, primary care physicians, and/or midwives to coordinate care throughout the pregnancy with the common goal of making this the best experience of your life!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
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.

Pregnancy and Low Back Pain – Part 2

3 Aug

Back pain can become both more frequent and more intense as a pregnancy enters into the second and (especially) the third trimester. This is because the biomechanical changes that accompany pregnancy occur too fast for the body to properly adapt.

Besides the usual suggestions of bed rest, taking frequent breaks, using cold packs, and the like, there are many benefits derived from manual therapies such as manipulation, mobilization, massage, and exercise.

Chiropractors frequently offer these services, and one or a combination of these therapies can result in significant relief of back pain during pregnancy. One study reported that 94% of pregnant women receiving chiropractic treatment demonstrated clinically important improvement with substantial relief for several days following their initial treatment, with no adverse effects.

In a survey of 950 pregnant women and 87 medical providers, 31% responded that effective alternative therapies used during pregnancy included chiropractic care, massage, and yoga exercises. In a review of 400 pregnant female medical charts after delivery, 84% reported relief of back pain during the pregnancy with chiropractic care.

Studies have also shown that women with back pain during pregnancy have an elevated risk for a longer labor and delivery. Additionally, first-time pregnant women (primigravida) who received chiropractic care throughout their pregnancy averaged a 25% shorter labor time, while women who were pregnant after already having a child (multiparous) reported a 31% average shorter labor time.

Co-management and referrals between medical providers and chiropractors are becoming more common due to the growing amount of evidence published regarding the benefits of spinal manipulation during pregnancy.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Pregnancy and Low Back Pain – Part 1

3 Jul

Did you know that between 50% of all pregnant women suffer from back pain and 50-75% experience back pain during labor?

There are MANY reasons why back pain becomes an issue for women during their pregnancy. The first and most obvious reason is the displaced weight gain of 25-35 pounds (on average) resulting in pain in both the upper quarter (often from the increase in breast volume and weight) and lower quarter (from the growing baby). As the baby develops, an expectant mother’s center of gravity moves forward causing her to sway back, which can overload the lower region of the spine. The women most at risk for pregnancy-related back pain include those who are overweight prior to their pregnancy, those who perform physically strenuous work, and those with a history of back pain.

Another factor that can increase a woman’s risk for back pain during pregnancy is water retention. Not only does retaining water increase the load the body must carry, placing added stress on the musculoskeletal system, but water retention has also been associated with stiffer joints throughout the body, which can increase the risk for musculoskeletal pain—including back pain.

The body requires more fluid during pregnancy to maintain the health of a growing baby, and drinking water is one of the best ways to hydrate. The American Pregnancy Association (APA) reports that the body produces 50% more body fluids during pregnancy.

Fluid retention is a common complaint during pregnancy. By the third month of pregnancy, approximately 50% of women notice swelling in their hands and feet and most have significant swelling by the third trimester. Sudden and new swelling in the face, hands, and eyes accompanied by blurred vision, severe headache, painful urination, and/or the inability to urinate with abdominal pain and hypertension (>140/90) may represent a medical emergency called pre-eclampsia. This occurs later in the pregnancy, usually after the twentieth week. If this is suspected, don’t delay in obtaining emergent medical care!

To combat fluid retention, avoid constrictive clothing around the wrists and ankles, rest with the feet elevated (especially when temperatures exceed 75-85º F / 25-30º C), use ice packs, wear comfortable shoes, and try support tights or stockings. Dietary options for reducing fluid retention include the use of certain herbs and vitamins, and foods such as celery, onions, eggplant, garlic, parsley, mint, bananas, coconut, dandelion, melons, salmon (omega-3 fatty acids), cucumber, and more.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Exercises on a Swiss Ball Help Back Pain Patients!

1 Jun

In previous articles, we’ve explored how to individualize an exercise program for those with back pain. This month, we’ll look at why utilizing a Swiss ball may be more helpful for the back pain patient than simply doing floor-based exercises.

In a 2015 study published in the Journal of Sports Science and Medicine, researchers assigned twelve chronic (more than three months) low back pain (cLBP) patients to perform either floor- or ball-based exercises three times a week for eight weeks using four different motions or exercises.

Though subjects in both groups experienced improvements, the gains were much greater for those in the Swiss/gym ball group regarding functional improvement. CT scans of the participants in the ball group also revealed an increase in the cross-sectional area of the deep low back stabilizing multifidus (MF) muscles.

So why did the swiss ball patients fare better? A strong possibility is that the use of unstable devices such as a gym or Swiss ball forces the neuromuscular system to work harder to maintain balance. This process not only improves propropception— the body’s ability to sense where its various parts are in relation to one another for purposes of movement and balance—but it also works out additional muscle groups that are involved in normal everyday movement that may not be activated when exercising from the floor or another stable surface.

The four Swiss ball exercises included in the study:
1) Bridge-1: Lay supine (on your back) with the ball under your upper back and bring one knee toward the chest to a 90/90° hip/knee angle; hold ten seconds and repeat five times with each leg.
2) Bridge-2: Lay supine with your upper back on the floor with the ball under the pelvis; push down into the ball with the pelvis for ten seconds and repeat five times.
3) Bird-dog (kneel on all-fours—quadruped position): Place a small ball (4-6”) under one knee (kneel on it) and slowly lift and straighten the opposite leg and balance for ten seconds and repeat ten times with each leg.
4) “See-Saw:” Lay on your stomach with the ball under the pelvis/hips, balance on the forearms, raise the legs, and do a scissors-kick (as if swimming) for ten seconds ten times with each leg.

We encourage proper form and working safely within “reasonable pain boundaries” that YOU define. Gradually increase reps and sets as you improve, modify the methods, and most important, HAVE FUN!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888 

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

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.

Have You Tried This for Your Back Pain?

1 May

It’s not uncommon for low back pain patients to reduce their activities in an effort to avoid their pain. Unfortunately, it’s likely their core muscles—the muscles that help support their midsection—will become deconditioned over time due to inactivity, which may only increase the risk of further injury. Therefore, to effectively improve one’s low back pain status, he or she must first strengthen and keep their core muscles strong! Think in terms of one to three sets of ten reps for ease of application and ALWAYS release the exercise SLOWLY—don’t just drop back from the end-range of the exercise.

The ABDOMINAL muscles include four groups: the rectus abdominis (they attach our rib cage to our pelvic area, and the fibers run straight up and down), overlapping on the sides are the internal obliques (fibers run down and inward), the external obliques (fibers run down and out), and lastly, the transverse abdominis (the fibers run horizontal and attach to the fascia in the low back).

If we think of three levels of exercise difficulty, an easy (or Level 1) sit-up can include a “crunch” or simply lifting the head and shoulders off the floor. A more difficult (Level 2) ab exercise would be to bend the knees and hips at 90 degree angles while performing a sit-up, while a more difficult (level 3) ab exercise could be a double straight leg raise during the sit-up. The rectus is stimulated by coming straight up and down while the overlapping obliques require a trunk twist. You can employ an “abdominal brace”, or holding the stomach muscles firmly as if someone is going to punch you in the stomach, in any position or activity during the day.

You can strengthen the LOW BACK extensor muscles using a number of effective exercises including (but not limited to) the “bird-dog” (kneeling on “all-fours”) straightening the opposite arm and leg separately (Level 1) and then simultaneously and switching back and forth (Level 2). Level 3 could be longer hold times, drawing a square with the hand and foot, or increasing the repetitions.

Another low back strengthener is called the “Superman”, which requires laying on the stomach (prone) initially lifting one arm and then the opposite leg separately (Level I); then opposite limbs at the same time (Level 2); and finally raising both arms and legs simultaneously (Level 3). Placing a roll under the pelvis/abdomen can make it more comfortable.

You can strengthen the SIDES OF THE CORE, or lateral trunk stabilizers, using a side-bridge or plank (laying on the side propped up between the elbow and feet, with the hips up and off the floor). Level 1 could be a six-second hold from the knees, Level 2 a six-second hold from the feet, and Level 3 could be a twelve-second hold between the elbow/forearm and feet. A modification could include slow repetitions of lowering the pelvis to the floor and back up. Mix it up!

There are MANY more exercises, but these should keep you going for a while! Remember, stay within “reasonable pain boundaries” that you define, release each exercise SLOWLY, and most importantly, have fun!

 

 

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

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.