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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.

Beliefs About Back Pain

8 Aug

Since the late 1980s, researchers have embraced the biopsychosocial model (BPS) to understand both the causative and prognostic factors associated with neuromusculoskeletal disorders, which includes back pain. In order to achieve the best possible outcomes for patients with back pain, it’s important to understand the role that factors outside of the biomechanical injury model play in both the injury and recovery processes. Unfortunately, there’s a lot of misinformation out there that can be detrimental to the patient.

In one study that included 130 low back pain (LBP) patients with persistent or recurring back pain, participants answered questions about the cause of their LBP, including what they’ve learned since receiving care. Their answers revealed that such patients see their LBP as: 1) due to the body being like a broken machine; 2) permanent; 3) complex; and 4) very negative. Nearly 9 in 10 patients (89%) indicated they learned these beliefs from healthcare professionals.

The study’s findings indicate that healthcare providers may be in the best position to educate patients about their condition. However, responses from 103 primary care physicians (PCPs) suggested that they considered biomechanical risk factors to be the most important short-term and long-term factors for a sudden episode of acute LBP.

When it comes to giving yourself the best possible chance of recovery from LBP, here are some things to keep in mind in addition to utilizing non-surgical treatments that are recommended by current guidelines, of which chiropractic care is an excellent choice: 1) Research has demonstrated that depression, anxiety, and self-limiting beliefs about future ability to work or do physical activity are psychosocial factors that are associated with poor outcomes.  2) Insufficient sleep and smoking are also lifestyle behaviors that can slow one’s recovery from injury, which includes low back pain! 3) Because movement is necessary to diffuse nutrients into cartilaginous tissue, it’s important to stay active during the recovery process to maintain joint health. Physical activity also keeps the muscles from deconditioning, especially the deep muscles that control posture.

Doctors of chiropractic are trained to approach treatment from a biopsychosocial perspective and to consider all factors that affect the patient’s chief complaint and quality of life. Through patient education, spinal manipulation, mobilization, exercise training, the use of modalities, and more, chiropractors can greatly help those struggling with back pain and other musculoskeletal conditions!

 

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.

Walking Backward for Chronic Low Back Pain

1 Jul

Kinesiophobia, the fear of movement, is a common occurrence for patients with chronic low back pain (cLBP). Unfortunately, self-restricting one’s daily physical activity can result in muscle weakness and atrophy. This can lead to further inactivity and more muscle weakness, and subsequently, poor tolerance of normal activities of daily living, work absenteeism, and depression. When the muscles around the low back or lumbar spine become atrophied and weak, the risk for acute flair-ups of low back pain (LBP) increases, leading to more dysfunction and distress.

Studies have reported that when comparing the muscles in the front of the lumbar spine (the “flexors”) to those behind the spine (the “extensors”) in individuals with cLBP, greater amounts of atrophy and weakness occur to the extensors. The lumbar multifidus (MF) muscles are crucial for maintaining stability of the lumbar spine, while the erector spinae (ES) superficial extensor muscles are known as “global stabilizers”, which are designed to produce gross movements and to counterbalance when lifting external loads.

When treating patients with cLBP, doctors of chiropractic commonly prescribe rehabilitation/exercise programs to improve motor control, muscle strengthening, stretching, and aerobic capacity. One such exercise that may be recommended is walking backward. Compared with walking forward, studies have shown that walking backward can lead to better results with respect to cardiovascular fitness and MF muscle activation (which as noted previously, are often weaker in cLBP patients).

Additionally, walking backward works the lower limb muscles to a greater degree while reducing stress on the patellofemoral joint (the kneecap). This is important, as knee pain can commonly co-occur with low back pain, especially in patients who are overweight/obese. Walking backward also stretches the hamstrings, which are often short/tight in cLBP patients.

So not only can walking backward benefit patients who already have back pain, but adding this activity to your exercise regimen may also reduce the risk for low back pain in the first place!

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 Care During Pregnancy for Back and Pelvic Pain

3 Jun

Low back pain (LBP) and posterior pelvic pain (PPP) are very common complaints during pregnancy. In fact, current estimates show that two-thirds of expectant mothers will experience back pain during pregnancy and one in five will report pelvic pain. These afflictions can have a significant impact on a woman’s quality of life and her ability to carry out everyday tasks. So, where does chiropractic care fit into this picture?

While some pain conditions associated with pregnancy may be related to changes in certain hormones, there is evidence that the growing fetus shifts the center of gravity forward in a woman’s body. This shift can greatly affect the biomechanics of the body and place added strain on the lumbar and sacroiliac joints, giving rise to pain in those areas.

A landmark 2014 study looked at the effect of chiropractic treatment on 115 pregnant women with LBP/PPP. In a nutshell, 52% improved with respect to pain and disability after just one week of care, 70% after one month, 85% after three months, and 90% after six months.

Interestingly, the patients who had LBP/PPP prior to pregnancy tended to have higher pain scores at the conclusion of the study than those without a previous history of LBP/PPP. This finding supports the theory that women who have a history of LBP prior to pregnancy are particularly good candidates for chiropractic care early in their pregnancy. Also, due to a common link between persistent LBP after pregnancy and pre-pregnancy LBP, chiropractic care post-partum may be equally important.

This study included many chiropractors in various locations, and treatment was not standardized to any one specific method or technique. That being said, high-velocity, low-amplitude spinal manipulative therapy was the most common approach utilized and is the “standard of care” utilized by most chiropractors around the world. As further research is conducted, it seems clear that the use of SMT during pregnancy will become “the norm.”

 

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.