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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
856 Century Drive, Suite C
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
856 Century Drive, Suite C
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
856 Century Drive, Suite C
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
856 Century Drive, Suite C
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.

What Many Back Pain Sufferers Can Do at Home

3 Apr

Low back pain (LBP) is a very common problem that affects most of us at some point in life and for some, it’s a daily issue. Through education and research, researchers have found low back-specific exercises can not only help get rid of LBP but can also prevent future exacerbations or episodes. Like brushing our teeth, low back exercises are equally important in order to maintain, preserve, and optimize function. But because there are SO MANY exercise options available, it’s hard to know which ones are best, especially for each specific person.

There are different methods for determining the right low back exercises for the patient. One of the most common is to try different exercises to determine individual tolerance, but this is not very specific, as it only determines whether or not the patient is comfortable with an exercise. Another is using physical performance tests (PPTs) that measure the strength and endurance of specific muscle groups, muscle shortness, balance, aerobic capacity, and spinal range of motion.

Physical performance tests are much more specific because they address each patient’s differences. Also, many PPTs include normative data to compare against the patient’s own performance, so repeat use of the abnormal PPTs on a monthly interval can gauge their progress (or the lack thereof), which is motivating to the patient and serves as a great outcome measure!

PPTs are typically done two to four weeks after an initial presentation or at a time when the condition is stable so as not to irritate the condition. Initially, the decision as to which exercise is best is often made by something called “directional preference” or positional bias. This simply means if a patient feels best by bending over, we initially give “flexion-biased” exercises.

Flexion-biased exercises include (partial list): pulling the knees to the chest (single then double), posterior pelvic tilts (flattening the low back into the floor), sitting and/or standing bend overs, hamstring stretches, and more. If a person’s low back feels best bending backwards, their doctor of chiropractic may give extension-biased exercises, which include (partial list): standing back bends, saggy push-ups (prone press-ups), and/or laying on pillows or a gym ball on their back, arching over the ball.

Chiropractors generally add exercises gradually once they’ve determined tolerance and will recheck to make sure the patient is doing them correctly. Studies show that spinal manipulation achieves great short-term results, but when exercise is added to the treatment plan, the patient can achieve a more satisfying long-term result. Unfortunately, other studies have shown that ONLY 4% of patients continue their exercises after pain is satisfactorily managed and they fall back into old habits of not exercising.

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

Do YOU Want to Avoid Back-Related Disability?

2 Mar

In 2008, a study published in the journal Spine sought to identify EARLY PREDICTORS in an effort to reduce the number of low back pain (LBP) patients who go on to experience long-term disability. Researchers followed 1,885 low back injury claimants for a year and then later reviewed data collected during the first three weeks following their injury to identify anything that might predict a greater risk of work-related disability one year later.

According to their findings, the factors that increase the risk of work-related disability include: injury severity, the type of healthcare provider from which they initially sought treatment; worker-reported physical disability, the number of pain locations, work-related stress; no available option for job accommodation (such as light duty); and a prior injury involving a month or more off work.

Of note, one VERY important factor mentioned in the study was the type of healthcare practitioner (HCP) the injured worker first consulted with for treatment. Those who sought chiropractic care initially were far less likely to become disabled (only 5%) than those who first visited doctors who specialize in primary care (12%), occupational medicine (26%), or “other” disciplines (23%).

Studies have also noted additional benefits by seeking chiropractic care for work-related musculoskeletal injuries versus other forms of healthcare delivery, as chiropractic care reduces the likelihood for extended time off work, results in less total healthcare costs, higher quality of life, fewer medications, fewer emergency department visits, and higher levels of patient satisfaction.

In addition, LBP Guidelines published in the United States and around the world consistently recommend spinal manipulation as a FIRST form of care for most types of low back pain based on these findings. We all have the option of seeking the type of care that we believe will best solve our problem. But with the findings reported in this and many other studies, evidence STRONGLY supports that seeking chiropractic IS the logical FIRST choice!

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org