Pain Relief Chiropractic

Based on simple statistics, we’ve ALL had (or at least will have) some form of low back pain (LBP) at some point in our lives. The term “chronic” applies to LBP that’s been present for at least three months. It has been consistently reported that LBP becomes increasingly difficult to resolve when it persists for three or more months. This month’s topic is about which exercises have been found to BEST address chronic low back pain (cLBP).

Many studies have investigated the effects of stabilization exercises in patients with chronic low back pain. In a review of six recently published studies that followed patients over a four to sixteen week time frame, investigators noted that participants who engaged in exercise (the use of a Swiss ball, floor or “land-based” exercises, sling exercises with some focusing on the abdominal muscles while others looked the extensors) reported improvements in pain and disability that were not seen among those in the non-exercise control groups. Additionally, one study also looked at changes in bone density between both groups and found increased bone density in the exercise group and a reduction in bone density among participants who refrained from exercise. Another study reported waist isometric strength increases in their exercise group.

One study found the cross section of the multifidus (MF) muscles—the deep low back, fine motor muscle groups that is considered to be one of the most important targets for low back strengthening—significantly increased after eight weeks of exercise. Another study observed the same effect for the deep transverse abdominis muscles.

These and other studies clearly show that core stabilization exercises can improve pain and disability scores in patients with cLBP, while those who do not exercise do not improve and in fact, may actually worsen! So, what are core stabilization exercises?

Here are some Swiss ball options (try 5-10 times and increase reps/hold times as you improve your strength):

1) Sitting pelvic tilts – This can be done with both feet (or eventually one foot when you’re ready for an added challenge) on the floor while rocking the pelvis front to back, left to right, or in a circular or “figure-8” manner.

2) Bridge – Start sitting and then walk out so the ball is between the shoulder blades. Keep your trunk parallel to the floor. Push your heels into the floor to activate the hip extensors (buttock muscles) and then walk back up to a sitting position. You can further challenge your balance and hip extensor strength by raising one leg.

3) Sit-ups – Start sitting and roll halfway back and hold it for different lengths of time.

4) See-Saw – Hug the ball and roll out into a push up position. Position the ball under your pelvis and lift one leg at a time towards the ceiling. Alternate between the left and right legs. You can do BOTH legs together once you get used to this to make it more challenging.

There are MANY other Swiss ball exercises, but these are some good ones to start with. Next month, we’ll look at similar floor or land-based pelvic stabilization exercises!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

As stated in previous articles, low back pain (LBP) can arise from many different structures. Lumbar facet syndrome is one that involves the facet joint and includes both acute (new) and chronic (old) varieties. The facet joint is synonymous with the zygapophyseal joint, so if you hear that word, don’t let it throw you off! Approximately 45% of patients with chronic low back pain suffer from “facet syndrome” (FS) in which the facets are the low back pain generator.

There are many conditions that give rise to FS. Some of these include the straining of the surrounding joint capsule (the capsule holds the joint securely together), joint hypomobility (reduced motion in the joint), a synovial cyst (similar to a ganglion on the back of the wrist but its located inside the joint), and degeneration (also called osteoarthritis—the wearing out type of arthritis).

Because facet syndrome can accompany other conditions, a doctor of chiropractic must evaluate each patient individually and manage each person appropriately. In “pure” facet syndrome, pain rarely ever passes the level of the knee and does not cause neurological loss (weakness, loss of reflex, etc.). It can create numbness but usually NOT beyond the knee. Pain is usually not worsened by hip movements such as straight leg raise or hip rotation.

The facet joint’s “job” (at least in part) is to limit or guard twisting movements in the upper lumbar/low back region, and the lower lumbar facets are shaped to limit motion when bending forwards and backwards. Facet joints are unique because they are innervated by specific nerves that can be blocked by injecting an anesthetic agent to determine if the facet (and its innervating nerve) is the main source of pain. The surrounding capsule around the facet joint contains mechanoreceptors (cells that detect movement) and nociceptors (cells that detect pain) that fire when the facet joint is compressed/jammed or over-stretched. These nociceptors can become “hypersensitized” (very irritable) when they remain inflamed over time.

In many patients, injury to a facet joint is the result of many microtraumas over a period of time and not one single isolated event. For example, repeatedly bending backwards, twisting, and leaning to one side can stretch the joint capsule and fatigue it until some capsular tissues finally “give” and it inflames which generates pain.

These joints commonly become arthritic with age, which is one reason people over 50-60 years old commonly present with FS. Osteoarthritis results in a narrowing of the joint space and causes a more permanently “jammed” joint. This is one reason many elderly people walk partially bent over—as bending forwards opens the facet joints and “feels good!”

The good news is that chiropractic manipulation is a highly effective treatment for facet syndrome, and most patients feel much better within the first or second week of care (often within three to five visits).

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues. To simplify the task of determining “What is causing my LBP?,” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly
managed by chiropractors.

Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results.

Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve rootrelated LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg.

The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “microtraumas” extending back in time that may be the “cause” of their current low back pain issues.

Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on — possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb.

Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.

Low back pain (LBP) is VERY likely to affect all of us at some point in life. The question is, do you control IT or does IT control you? Here are ten “tricks” for staying in control of “IT!”

• STRETCH: When you’re in one position for a long time (like sitting at your desk), SET your cell phone timer to remind yourself to get moving and stretch every 30-60 minutes! Mornings are a great time to stretch.

• BE SMART: Do NOT place your computer monitor anywhere other than directly in front of you. Shop carefully for a GOOD supportive office chair that is comfortable and a good fit.

• POSTURE: For sitting, sit as upright as comfortably possible keeping your chin tucked in so the head stays back over the shoulders.

• SHOE WEAR: Avoid wearing heels greater than one inch high (2.54 cm). A supportive shoe that can be worn COMFORTABLY for several hours is ideal! Generally, the “skimpier” the shoe, the worse the support, so don’t “skimp” on shoe wear!

• SMOKING: Carbon monoxide from cigarette smoke competes with oxygen at each cell in the body literally suffocating them, which makes the healing process more difficult.

• WEIGHT: Your body mass index (BMI) should be between 18.5 and 25. Search the internet for “BMI Calculator” and plug in your height and weight to figure out yours. BMI is a reliable indicator of body fatness and a great way to determine where you are at for goal setting.

• ANTI-INFLAMMATION: Common over the counter (OTC) medications include ibuprofen and naproxen. However, recent studies show these types of medications (NSAIDS) may delay the healing process. A healthier choice is ginger, turmeric, and bioflavonoids, which are commonly bundled together in a supplement. Eat fresh fruits, veggies, lean meats, and food rich in omega-3 fatty acids. Vitamin D, magnesium, and coenzyme Q10 are also smart choices. AVOID FAST FOOD as they tent to be rich in omega-6 fatty acids, which can promote inflammation.

• ICE: This could be included in #7 but deserves its own space. Ice reduces swelling while heat promotes it. Try rotations of ice every 15-20 minutes for about an hour three times a day to “pump” out the swelling!

• STAY ACTIVE: Balance rest with physical activity like exercise or simply going for a walk. The most important thing is to move your body around.

• STRENGTHEN: Core stabilizing exercises (sit-ups, planks, quadruped) and BALANCE exercises are VERY important!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Most of us have suffered from back pain at one time or another. It often occurs after over-doing a physical task, like fall yard work, winter snow shoveling, working on the car, cleaning the house, and so on. But there are times when identifying the cause of back pain can be difficult or impossible. Let’s take a deeper look at where back pain can come from…

Though activity-related back pain is common, many times a direct link to over-use is not clear. Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. (Think of the old adage “The straw that broke the camel’s back.”)

There are other less well-identified causes of back pain. One is called referred pain. This can be caused by an irritated joint or soft tissue not necessarily located in the immediate area of the perceived pain. For example, pain in the leg can result from an injured facet joint, sacroiliac joint, and/or a disk tear (without nerve root pinch). This is called “sclertogenous pain.”

Internal organs can also cause back pain. This is called a “viscerosomatic response” (VSR). A classic example of this is when the right shoulder blade seems to be the source of pain when the gall bladder is inflamed. This pain can be located at or below the scapula next to the spine and the muscles in the area are in spasm and sensitive or painful to the touch. Also, VSR is often not worsened or changed by bending in different directions (unlike musculoskeletal / MSK pain). Without further testing, it’s easy to confuse this with a MSK or a “typical” back ache. Ultimately, a final diagnosis may require an abdominal ultrasound (CT, MRI scan, and other diagnostics are less frequently used).

Visceral pathology in the back pain patient presenting to chiropractors is reportedly rare, and according to one survey, only 5.3% of patients present with non-musculoskeletal complaints. Other common VSR pain patterns are as follows: Heart – left chest to left arm, mid-upper back, left jaw; Liver – right upper shoulder (front and back), right middle to low back, and just below the sternum; Appendix – right lower abdomen (may start as stomach pain); Small intestine – either side of the umbilicus and/or between it and the breast bone; Kidney – small of the back, upper tailbone, and/or groin area; Bladder – just above the pubic bone and/or bilateral buttocks; Ovaries – groin and/or umbilical area; and Colon – mid-abdominal and/or lower quadrants.

Another challenge to diagnosis is cancer in the spine, which can be primary or metastatic (from a different location). Thankfully, this is very rare. A history of unexplained weight loss, a past history of cancer, over age 50, nighttime sleep interruptions, and no response to usual back care may lead a doctor to recommend tests to determine if cancer is present in the spine.

Bottom line: When patients present with back pain, chiropractors have been trained to look for these less common but important causes of back pain. They get “suspicious” when the “usual” orthopedic tests do not convey the usual responses seen with mechanical back pain. In these cases, they work with primary care doctors to coordinate care to obtain prompt diagnostic testing and treatment.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Spondylolisthesis, or a slipped vertebra (as opposed to a slipped disk or herniated disk), is when one vertebra slips or slides forwards on the vertebra below, which can occur for a number of reasons including getting older (“degenerative spondylolisthesis”) or trauma (from a fracture in the back of the vertebra called the “pars interarticularis”). Additionally, one can be born with it (congenital), or spondylolisthesis can occur early in life while the spine is still developing. The most common method of measuring the amount the vertebrae slides forwards is done by the percentage of slip (such as 50% is when a vertebra has slid forwards halfway over the adjacent lower vertebra).

This can happen anywhere in the spine (the neck, mid-back, or low back), but it is most commonly seen in the low back, particularly at the lowest levels (L4 and L5). This occurs in about 3-6% of the population; however, in certain populations, the incidence rate can be three times (or more) higher. For example, certain Inuit populations carry their babies vertically in a papoose that overloads the child’s young spine during development, which results in a greater prevalence of spondylolisthesis among that group.

Some studies report that spondylolisthesis usually develops at a very young age, and certain pelvic alignment findings may contribute to whether it is likely to occur, such as a “sway back” posture (increased sacral slope).

An interesting study looked at how often spondylolisthesis is found in subjects with NO low back pain. Researchers reviewed 510 cases of patients presenting with abdominal pain and other non-spine related complaints and found spondylolisthesis in 16 cases (3.1%).

So there you have it! If you have spondylolisthesis, you may have 1) No back pain, 2) Pain related to something entirely different and separate from it; or 3) Pain directly related to it.

In some cases, the cause of a patient’s back pain may be due to spondylolisthesis caused by an unexpected backward bend of the lower back (like a slip and fall, sports injury, etc.) with immediate pain that increases with backward bending. However, in many cases a patient may present with spondylolisthesis that is stable, old, and has nothing to do with their present complaint. A thorough case history and examination will indicate which is more likely the case so that treatment can focus on the likely cause of the patient’s pain.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888