Archive | Back Pain RSS feed for this section

Low Back Pain and Directional Preference for Exercises

10 Feb

Several studies have found that a treatment approach that combines specific exercises with spinal manipulation, mobilization, and nutrition is often ideal for reducing pain and improving function in patients with low back pain. But how does your doctor of chiropractic know which low back exercises to recommend and which to avoid? The answer: it depends.

Because each patient is unique (age, health status, fitness), it’s clear that exercise prescriptions need to be individually tailored to be safe and to avoid injury. Perhaps one of the most important tools your doctor will take into consideration is the concept of directional preference. That is, which position helps your back feel good or bad? From a sitting position, first slump and slouch and then ask yourself, “Does this feel good, bad, or no different?”

Next, sit up straight and arch your lower back and ask the same question. Do you prefer one over the other? If so, the position in which you feel BEST is YOUR directional preference.

Using that concept, let’s say you feel best slumped and slouched, which is quite common. What are the “BEST” exercises for this flexion directional preference (FDP)?

  • While laying down and facing upward, pull one knee to the chest followed by the other, repeating five to ten times each (staying within reasonable pain boundaries).
  • While laying down and facing upward, flatten and “push” the arch of your lower back into the floor by rocking your pelvis forward and hold three to five seconds, repeating five to ten times.
  • While sitting, bend forward and try to touch your toes. Repeat multiple times a day as needed.

If you feel best in the arched sitting posture, then the ideal exercises for you may be those that utilize the extension directional preference (EDP):

  • While sitting or standing, place your hands behind your back, and arch your back over your hands (as far as comfortably allowed). Hold for three to five seconds, repeat five to ten times.
  • Sit up as arched as your can and try to hold that position as long as possible when doing sitting tasks (computing, driving, etc.).
  • Do a “saggy push-up” (also called a “Cobra,” or prone press-up) by keeping your hips on the floor while doing a push-up, arching the low back.

You can improvise and make up your own exercises using this concept, but while some discomfort is to be expected, avoid sharp lancinating pain. If you don’t have a directional preference and feel good in both positions, do ALL of the above! Your doctor of chiropractic can help monitor and train you in these and many more exercises as part of your treatment plan to reduce back pain and improve back function.

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.

Spinal Stenosis and Non-Surgical Care

2 Jan

It’s common to see older adults with a slumped posture, and though there are many possible reasons for this, perhaps the most common cause is a condition called spinal stenosis.

The Mayo Clinic notes that spinal stenosis can result from wear-and-tear that narrows the spinal disks. This narrowing can place pressure on the nerve roots as they exit the spine prior to traveling down into the legs. The symptoms—which can include pain, numbness/tingling, and weakness—typically come on gradually and may worsen over time. The spinal stenosis patient may feel more comfortable by leaning or bending forward as this posture opens the holes in the spine (the foramen), taking pressure off the nerves.

Because spinal stenosis is a condition caused by wear-and-tear, some individuals may be at more risk than others, especially those with a history of spinal/disk injury, heavy labor, poor nutrition, or obesity.

The good news is that patients with spinal stenosis can benefit from non-surgical approaches!

In a 2019 randomized trial involving 259 seniors with spinal stenosis, researchers compared the effectiveness of three approaches: medical care (including epidural steroid injections), group-based exercise, or manual therapy (spinal mobilization performed by a doctor of chiropractic) with individualized exercise (stretches and strength training).

While participants in the medical care and exercise-only groups reported some benefits, the research team noted that the patients in the manual therapy plus individualized exercise group experienced greater improvements with respect to pain, function, and walking ability.

The “take-home” message here is that in all three measured outcomes—pain, function and walking ability—the chiropractic approach did the BEST!  If you suffer from spinal stenosis and its associated symptoms and walking limitations, PLEASE consider chiropractic not only as an option but perhaps as this study points out, the BEST option!

 

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.

Traction for Low Back Pain?

16 Dec

In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.

In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.

With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.

For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.

The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.

For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more—including in-office or at-home traction, if warranted.

 

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.

Nerve Flossing and Low Back Pain

7 Nov

The sciatic nerve is made up of five nerve roots that exit the spine in the lower back (L4 to S3) and then merge into one nerve that travels through the buttock and into the leg. At the back of the knee, the nerve divides into two nerves, the tibial and common peroneal, that travel into the inner and outer lower leg and foot.

When the sciatic nerve is compressed or pinched, a patient can feel pain, tingling, numbness, and even weakness in the hip, buttock, and leg. For individuals under the age of 60, the most common cause of sciatica is a herniated disk. For older adults, the most likely causes of sciatica are spinal stenosis (a narrowing of the openings of the spine the nerves travel through) and spondylolisthesis (when one vertebra slides forward on the neighboring vertebra).

Normally, a nerve root moves freely in and out of the spine through holes located between each vertebra called intervertebral foramen (IVF). Movements or exercises such as hamstring stretches or punting a football create tension on the sciatic nerve and pull the nerve roots out of the IVFs. Similarly, when we stand up straight and look down at our feet, this pulls the spinal cord upward and the nerve roots move into the IVFs.

When managing sciatica, chiropractors will utilize a technique called nerve flossing. Like flossing teeth, the back and forth motion of the dental floss is conceptually the same action as the back and forth motion of the five nerve roots that merge into the sciatic nerve. To pull the nerve roots out of the IVF, extend the head/neck upward and then flex the foot/ankle upward as well (toes toward the nose). To pull the nerve back into the IVF, point the foot/ankle downward while the head/neck flexes forward (chin to chest). Repeat multiple times as long as pain or other symptoms do not worsen. The idea behind this is to free up the nerve root by reducing adhesions in the IVF.

Nerve flossing is usually performed first by a doctor of chiropractic to make sure it is well tolerated and safe so that the patient can perform the exercise at home several times a day. Studies show that this method helps reduce tension on the sciatic nerve while also stretching the hamstrings, which are often tight in patients with low back pain.

 

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.

Staying Active Helps the Lower Back

10 Oct

In the past, patients may have been prescribed bed rest by their family doctor for low back pain. These days, treatment guidelines recommend staying active during the recovery process. Why the change?

There are two types of muscles in the back: the superficial muscles and the deep muscles. The superficial muscles are used to perform motions like bending and twisting. These muscles are strengthened by exercise that places stress on the muscles, like lifting weights. The deep muscles help stabilize the spine and maintain posture, and physical activity helps keep them in shape.

When a person goes on bed rest, the muscles in the back will weaken and begin to atrophy. As activity is resumed, the body will recruit the superficial muscles to help stabilize the back. Because the muscles are not adapted for this function, the superficial back muscles will tire more easily, and in the presence of deep muscle weakness, normal movement will be impaired. This can place abnormal stress on the structures in the spine and other parts of the body, increasing the risk for additional musculoskeletal injuries.

Bed rest can also affect the disks that act as “shock absorbers” in the spine. In one study, researchers recruited 72 middle-aged adults and assessed their physical activity levels in the preceding years based on how many days they engaged in strenuous activity every two weeks: active (9 to 14 days), moderately active (1-8 days), or inactive (0 days). About one in five (21%) were classified as active, half (53%) were described as moderately active, and the remainder (26%) were inactive.  The researchers also performed an MRI on each participant and gathered information on low back pain-related pain and disability.

The results clearly showed that physically inactive individuals were more likely to have back pain, reduced function, loss of disk height, and fat build-up in their back muscles. The research team concluded that getting regular, regimented exercise throughout life is important for reducing the risk of back pain.

There are very specific exercises that help strengthen the deep, low back stabilizing muscles. Doctors of chiropractic regularly prescribe exercise to address an acute flair-up of LBP and to help prevent future occurrences.

 

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.

When Spinal Fusion Is Needed…

5 Sep

You’ve probably heard of a friend or loved one whose back pain resulted in a spinal fusion surgery, but you may not understand what prompted surgery over non-surgical approaches, including chiropractic care.

Simply put, spinal fusion is a surgical technique that aims to eliminate excessive motion (instability) in the spine by fusing two or more vertebrae together. Fractures related to trauma are a common reason for spinal instability, but excessive motion can also be caused by conditions such as spondylolisthesis (when one vertebra slides forward on another) and age-related disk degeneration.

When is a fusion necessary? The short answer is after every non-surgical option fails to result in a satisfactory outcome. The long answer is when there is progressive neurological loss or deficit, cauda equina syndrome, failed non-surgical care, failed prior surgical care, x-ray evidence of instability with neurological signs, and unremitting pain that affects one’s quality of life. Treatment guidelines are not always followed, as many patients consult with a doctor of chiropractic only after they’ve already been advised that their lower back condition requires surgery.

The good news is that most conditions of the lower back can be managed with non-surgical chiropractic care, especially early on. With any musculoskeletal injury, it’s almost always best to seek care right away when the symptoms may be milder. Ignoring an injury may cause it to worsen and/or lead to the formation of scar tissue in the affected area and secondary problems elsewhere as the body attempts to compensate for mobility impairments. Conditions like chronic back pain can still respond well to chiropractic care, but keep in mind, it may take longer to achieve a successful outcome.

However, there are times when surgery is necessary.  Surgery may include decompression of the nerve without fusion, but in cases of spinal instability, fusion may be needed, which is determined on a case-by-case basis. There are always risks associated with surgery, which is why it’s so important to exhaust non-surgical options first. When appropriate, your doctor of chiropractic can help facilitate in the referral process for a surgical consultation.

 

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.