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 our chiropractor at Coastal Medical and Wellness Center.
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 root-related 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 “micro-traumas” 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 Stuart, FL Doctor of Chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.
Headaches (HA) play a significant role in a person’s quality of life and are one of the most common complaints that our Stuart FL chiropractor sees. This comes as no surprise, as one survey reported 16.6% of adults (18 years and older) suffered from migraines or other severe headaches during the last three months of 2011. Another study reported that head pain was the fifth LEADING CAUSE of emergency department (ED) visits in the United States and accounted for 1.2% of all outpatient visits. These statistics are even worse for females (18-44 years old), where the three-month occurrence rate was 26.1% and the third leading cause for ED visits! Because of the significant potential side effects of medications, many headache sufferers turn to non-medication treatment approaches, of which chiropractic is one of the most commonly utilized forms of “complementary and alternative approaches” in the management of tension-type headaches. So, why are headaches so common? Let’s talk about posture!
Posture plays a KEY ROLE in the onset and persistence of cervicogenic (originate in the neck) headaches. If there is such a thing as “perfect posture,” it might “look” something like this: viewing a person from the front (starting at the feet), the feet would flair slightly outwards symmetrically, the medial longitudinal (inside) arch of the feet would allow enough space for an index finger to creep under to the first joint (and NOT flat like so many), the ankles would line up with the shin bones (and NOT roll inwards), the knees would slightly “knock” inwards and hips would line up squarely with the pelvis. The shoulders would be level, the arms would hang freely and not be pronated (rolled) inwards, and head would be level (not tilted). From the side view, the knees would not be hyperextended nor flexed, the shoulders would not be forward (protracted) and MOST IMPORTANT (at least for headaches), the head would NOT be forward and be able to have a perpendicular line drawn from the floor through the shoulder, as this line should pass through the outer opening of the ear. As the head “translates” or shifts forwards, for every inch of “anterior head translation” (AHT), it essentially gains 10 pounds in weight, which the upper back and neck muscles have to counter balance!
A leading University of California medical author, Dr. Rene Calliet, wrote that this altered posture can add up to 30 pounds of abnormal weight to the neck and can “…pull the entire spine out of alignment.” It can also reduce the lung’s vital capacity by 30%, which can contribute to all sorts of breathing-impaired health problems! Think of carrying a 30-pound watermelon around your neck all day—the muscle pain from fatigue would be tremendous! If this is left uncorrected, chronic neck pain and headaches from pinching off the top three nerves in the neck is likely. The combination of AHT and shoulder protraction may also lead to the development of an upper thoracic “hump” and potentially into a “Dowager Hump” if the mid back vertebrae become compressed (wedged). An increased rate of mortality of 1.44 is reportedly associated with this faulty posture!
Between chiropractic adjustments, posture retraining exercises, other postural corrective care, and strength exercise training, your doctor of chiropractic WILL help you correct your faulty posture so that neck pain and headaches STOP and don’t progress into a chronic, permanent condition.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
For patients with chronic low back pain (cLBP), treatment guidelines recommend a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to avoid an initial surgery unless it’s absolutely indicated. That means, unless there is loss of bowel or bladder control or retention (which represents a medical emergency) or if there is progressive neurological motor and sensory loss, one can safely avoid surgery and conservatively manage the condition.
Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up!
Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone.
The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care.
The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone.
The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.”
Can Chiropractic Help The Post Surgical Patient
Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek eras that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember?
Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! So, the questions this month are: How successful IS spinal surgery? What about all those patients who have had surgery but still have problems – can chiropractic still help them?
A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches (like chiropractic care) are the most effective treatment choice. They report the success rate of spinal fusions for DDD is only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. The authors of the review wrote, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it… Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for ten years following artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.
So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!
Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!
People of all ages suffer from neck pain, and many frequently turn to chiropractors for care because it’s been found to be one of the most effective and efficient forms of treatment available, and it carries minimal side effects! It has been projected that by 2030, nearly one in five residents in the United States will be 65 or older. Currently, approximately 14% of the patients treated by chiropractors are 65 or older, making it one of the most frequently utilized forms of complementary and alternative care used by older adults. What kind of care can a senior citizen expect when seeking treatment from our Stuart, FL chiropractor? Let’s take a look…
Musculoskeletal pain—pain in the neck, back, arms, and/or legs—drives the majority of elderly patients to chiropractors. While low back and neck pain are the most common complaints, it’s not unusual for patients to also have one or two other conditions (or more) that they did NOT know chiropractic care could help. In fact, common “goals” for managing every patient (not just the elderly) include services related to patient assessment, maintenance of health, and prevention of illness, in addition to treatment of illness or injury. Common chiropractic treatment approaches include spinal manipulation and/or mobilization, nutritional counseling, physical activity/exercise, and (especially important for the elderly population) fall prevention.
We will now focus on neck pain as it relates to the elderly population and the various chiropractic management strategies that might be encountered by an elderly patient. Common reasons patients present regarding the neck include limited movement, stiffness, and pain. Neck pain can also interfere with sleep, as finding a comfortable position in bed can be quite challenging! Lifting, carrying, and playing with grandchildren is a very common issue for either causing a new complaint or irritating an existing one. Neck pain may also interfere with reaching and lifting. Thus, activities like yard or garden work may become more difficult and less enjoyable. Neck pain is often associated with headaches, which can make daily tasks even more challenging.
When an elderly patient visits a chiropractor at Coastal Medical and Wellness Center for the first time or for a new complaint, he/she can expect to fill out some initial paperwork, as well as provide a history of the main complaint and any lesser complaints. This may also include providing a family and medical history. The examination usually includes general observations, palpating or feeling for muscle tightness, tenderness, warm/cool, range of spinal motion (neck, back, extremities), orthopedic tests, neurological tests, and possibly x-rays. Treatment of the neck may include massage or mobilization to loosen up the neck, manipulation to free up restricted joint motion, and even exercise training. The goal of treatment is to improve neck motion, activity tolerance, and quality of life (less pain, improved sleep, etc.). So, whether you are 10, 20, 50, 70, or 90 years old, give our Stuart, Fl chiropractic office a chance to help you manage your neck pain!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Sinus headaches refer to pain in the head, typically in and around the face. Most of us are knowledgeable about two of our four sinuses: the frontal (forehead) and maxillary (our “cheek bones”). The other two sinuses (called ethmoid and sphenoid) are much less understood. Many patients ask our Stuart chiropractor about sinus problems, as all of us have had a stuffy nose due to a cold and have felt this pain in our face and head. Those of us who have suffered from sinus infections REALLY know how painful sinusitis can get! This month, let’s take a look at our sinuses and what we can do to self-manage the problem.
First, an anatomy lesson… As stated above, there are four paired, or sets, of sinuses in our head: Maxillary: Pain/pressure in the cheekbones, sometimes referring pain to the teeth. These drain sideways (if you lay on your side, the side “up” drains down into the downside maxillary sinus and into the nose). Frontal: Pain/pressure in the forehead. These drain downward (when we’re upright, looking straight ahead). Ethmoidal: Pain/pressure between and/or behind the eyes. These drain when we lean forwards. Sphenoidal: Cause pain/pressure behind the eyes, top of the head and/or back of the head (which can be extreme). These drain best when lying face pointing down towards the floor, but they can be stubborn to drain!
Sinusitis, or rhinosinusitis, by definition is an inflammation of the sinus lining (mucous membrane) and is classified as follows: Acute – a new infection which can last up to four weeks and are divided into two types: severe and non-severe; Recurrent acute – four or more separate acute episodes within one year; Subacute – an infection lasting 4-12 weeks; Chronic – infections lasting >12 weeks; and Acute exacerbation of chronic sinusitis – recurring bouts of chronic sinusitis.
One cause of sinusitis can include a “URI” (upper respiratory tract infections) most often in the form of a virus (such as rhinovirus—there are over 99 types have been identified—or better known as “the common cold”). Bacteria can also cause a sinus infection. These infections tend to last longer and can follow a viral infection. A third cause is a fungal infection. These are more common in diabetic and other immune-deficient patients. Chemical irritants such as cigarette smoke and chlorine fumes can also trigger sinusitis. Chronic sinusitis in Stuart fl can be caused by anything that irritates the sinuses for >12 weeks (viruses, bacteria, environmental irritants, tooth infections, and more). Allergies are also a common cause of sinusitis whether they are environmental and/or food/chemical induced.
Chiropractic care for sinusitis includes primarily symptomatic care with sinus drainage techniques such as facial and cranial bone manipulation/mobilization, lymphatic pump and drainage techniques, instruction in self-stretch of the sinuses (such as an outward pull of the cheek bones in different positions of the head), nutritional counseling (such as 1000mg of vitamin C every 2-4 hours) and anti-inflammatory herbs and vitamins (see prior Health Updates), cervical and mid-back manipulation, training in nasal saline rinsing (Nasaline, Nettie Pot), moist heat (towels, steam), and of course, chicken soup! Co-management with your primary care doc may be needed at times, if medications are warranted.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!
Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you’ll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.
When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain.
Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is
caused from lack of blood flow to the leg(s) as opposed to nerve flow.
At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot.
In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Our chiropractic in Stuart, FL offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended choice in LBP guidelines as an option when treating these conditions.
Content provided by Chiro-Trust.org
Neck pain is one of the most common complaints patients have when they come to our chiropractic office in Stuart, FL for the first time, second only to low back pain. Neck pain affects all of us at some point in life, and for some, it can become a chronic, permanent problem that can interfere with many desired activities and lower their quality of life. There are many different causes, and prompt evaluation and treatment is important is some cases.
Neck pain and stiffness are the two most common symptoms that present for evaluation and treatment. This can be located in the middle of the neck and/or on either side and can extend down to the shoulders and/or chest. It can contribute to or cause tension headaches that can travel up the back of the head and sometimes behind the eyes. Pain often increases with neck movement, such as when turning the head to check traffic while driving and/or it can hurt at rest while held in static positions, such as when reading a book. Neck pain can come on gradually or quickly and often cannot be traced to a specific injury or cause making it a challenge to figure out. While neck pain is often not serious or life-threatening, there are causes that should be evaluated promptly. If you wake up with acute neck pain associated with very limited range of motion, this may be due to torticollis, or wry neck, and prompt treatment helps it resolve more quickly than “waiting it out.” Torticollis can be caused by exposure to a draft, changes in weather, trauma, or after a cold or flu. When in doubt, come in for an evaluation and treatment, as anxiety associated with the “fear of the unknown” only adds to the stress associated with neck pain and it’s ALWAYS best to be “…safe than sorry!”
Numbness or tingling may accompany neck pain and can be located in the face, arms, hands, and/or fingers. This is one of those times to come in promptly, as these symptoms may indicate the pinching of a nerve root in the neck. There are MANY chiropractic treatment approaches that effectively treat nerve root pinching, and treatment should NOT be delayed. Other common symptoms may include clicking, crunching, or grinding noises, technically called crepitus, which may or may not be benign. If the noise is accompanied by pain, especially if it radiates down to the shoulder blades or arms (either side or both), it’s time to promptly come in. Any time symptoms occur acutely or come on fast, it’s best to get evaluated as soon as possible.
Dizziness is another common symptom that can result from neck problems and is often associated with movement such as rising from laying or sitting. Certain positions of the neck can also bring on dizziness. This is sometimes caused by the “stones” in the inner ear shifting out of position and is technically called BPPV or benign paroxysmal positional vertigo. When this occurs, we can usually manage it very well with treatment and specific BPPV exercises. Other times, dizziness may be due to a restriction in blood flow reaching the brain. In which case, a prompt evaluation is VERY appropriate, especially if blackouts occur.
Sleep interruption or difficulty falling asleep are other good reasons to seek prompt evaluation and treatment. Sleep loss can lead to many problems such as excessive fatigue, tiredness, irritability, and just generally feeling poor! Remember, prompt care usually results in prompt resolution!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Low back pain (LBP) can strike at any time or place, often when we least expect it. There are “self-help” approaches that can be of great benefit, but many of these approaches can fail, or worse, irritate the condition. Here are some “do’s and don’ts” when self-managing low back pain!
Ice vs. Heat? Typically, people are almost always confused about which is better, ice or heat? This decision can be significantly helpful or hurtful, depending on the case. Generally, “ice is nice,” as it vasoconstricts and pushes out inflammation or swelling, which usually feels relieving and helpful even though the initial “shock” of ice may not be too appealing to most of us! This is probably why MOST people will wrongly choose heat as their initial course of self-care.
This is usually wrong because heat vasodilates, which draws blood into the injured area that is already inflamed and swollen, thus adding more fluid to the injured area—sort of like throwing gas on a fire! Heat may feel good initially, but often soon after, increased pain intensity and frequency may occur. When LBP is chronic or NOT new/acute, heat can be very helpful, as it relaxes muscles and improves movement by reducing stiffness (but never use heat more than 20 minutes per hour).
The biggest mistake about the use of heat is leaving it on too long—some people even burn themselves with a heating pad they’ve left on for hours of continuous use—sometimes overnight (PLEASE DON’T DO THAT!). When using ice, there are MANY ways one can apply it. If you only have 5-10 minutes, that is better than nothing! However, an ideal approach is to apply the ice pack or bag as follows: On 15 min. / off 15 min. / on 15 min. / off 15 min. / on 15 minutes (total time: 1:15 hr). The “off 15 minutes” helps the area to warm up by allowing the blood to come back into the low back area, which avoids frost bite and sets up a pump-like action.
Even better is an approach called “CONTRAST THERAPY” where we start and end with ice and use heat in between as follows: ICE 10 minutes / HEAT 5 min. / ICE 10 min. / HEAT 5 min. / ICE 10 min. (total time: 40 minutes). This approach creates a stronger pump-like or “push-pull” action that pushes out fluids/inflammation (with ice) followed by pulling in fluids (with heat). Both approaches are effective! If you ever feel worse after icing, PLEASE STOP AND CONTACT YOUR LOCAL DOCTOR OF CHIROPRACTIC in Stuart, FL, as you may have a unique case or situation.
How active should I be? Here too, most people usually try to do too much even after they feel “warning signs”. It’s human nature to want to “…get things done,” so sometimes we push ourselves beyond the limits of our tissue’s capacity, resulting in an injury. Once we’ve hurt our back, we STILL try to stay with our daily routine, ignoring our LBP the best we can. Generally, it’s BETTER to be a little active than it is to be too sedentary, but there is also a limit, as too much activity is like “…picking at a cut,” only prolonging healing and recovery.
If every time you bend over results in a sharp, dagger-like pain in your low back, PLEASE STOP and assess the situation! Position preference is the KEY to determining what type of stretches or other exercises may be best for you. So, if bending over REDUCES LBP, pull your knees to your chest (your local doctor of chiropractic in Stuart, FL can show you how)! If bending backwards feels better, our Coastal Medical and Wellness team can show you several extension exercises that can be done multiple times a day. Remember, too much sitting or lying down will weaken your low back muscles. Emphasize positions that feel good and avoid sharp, lancinating pain!
Have you ever had neck or back pain and considered Chiropractic but feared you’d be required to commit to a long term plan?
You are not alone.
Even though there is plenty of research backing up Chiropractic, some patients just can’t afford the time or expense of long-term, corrective care.
That is why we now offer “pay per visit” Chiropractic for your neck pain or back pain.
This means you can call and come in on the same day and provided that there are no contraindications, get exactly what you want; an adjustment without pressure to keep coming back over and over again.
As a matter of fact, this mainstream approach is featured on Chiro-Trust.org… one of the most visited online back pain information websites in the country.
So, if you, your spouse, or a friend is complaining of aches and pains, rest assured that you can come in and get the care you want and can afford.
Give us a call at 772-286-5277. We’ll take good care of you.
Cliff Atwell, B.S., D.C.