Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.
The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed by “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!
Reprinted via Chirotrust
Our Condition of the Month is Sacroiliac Joint Dysfunction. Keep reading to learn more about this condition:
Sacroiliac Joint Dysfunction:
Your sacroiliac joint is the mechanical link on each side of your hip that connects your legs to the rest of your body. The joint has a limited but very important degree of mobility. Symptoms develop when one or both of the joints loses normal motion. When a joint becomes "restricted", a self-perpetuating cycle of discomfort follows. Restriction causes the muscles to become overworked, leading to tightness, compression, inflammation, pain and more restriction.
Sacroiliac problems can happen as a result of repetitive strenuous activity or trauma- like a fall onto the buttocks. Other causes of sacroiliac joint problems include, poor posture, having one leg slightly longer than another, having an altered gait, having flat feet or scoliosis, or having pain somewhere else in your legs. Pregnancy is a common trigger for sacroiliac joint problems due to weight gain, gait changes and postural stress.
Sacroiliac joint problems often begin as a focal discomfort in your back just below the belt line, slightly to one side of center. Your pain can travel into your buttock or thigh. Symptoms are often worse by standing on the affected side. The pain may become more apparent when you change positions- like exiting a chair, car or bed, or during long car rides. The pain is often relieved by lying down.
To assist with your recovery, you should avoid any activity that provokes pain, like standing on the affected leg or prolonged sitting.
If you are experiencing any of these symptoms, be sure to call us for an evaluation.
Did you know that 80% of adults experience low back pain at some point in their lifetimes? It’s the leading cause of missed workdays and job-related disability. Although it’s incredibly common and potentially debilitating, the good news is that most cases of low back pain originate from mechanical causes, which means they aren’t caused by a disease and can be prevented with healthy habits. If you want to keep your back healthy, take these six tips into consideration.
1. Don’t Slouch. Poor posture puts a great deal of strain on your back. Be mindful of your posture whether you’re sitting in an office chair at work, driving, or texting on your cell phone. If you’re unsure of what proper posture looks like, watch this video that covers proper sitting posture.
2. Don’t Be A Couch Potato. People with sedentary lifestyles tend to have more occurrences of back pain. Sitting for prolonged periods of time contributes to many different ailments, including low back pain; so challenge yourself to move your body more often throughout the day.
3. Don’t Smoke. Studies show that smoking increases your chance of having low back pain. If you want to quit, SmokeFree.gov can help.
4. Don’t Sleep On Your Stomach. This position places excessive stress on your spinal joints and muscles. A better option is to sleep on your back with a pillow under your knees or on your side with a pillow between your knees. This keeps the spine elongated and neutral. View our sleep posture tutorial video here.
5. Don’t Ignore Your Core. Weak abdominal muscles can contribute to low back pain. If your core is weak, then your back muscles have to work harder to support your movements. This extra work often contributes to strain and injury. We commonly prescribe the Dead Bug, Bird Dog, and Side Bridge exercises to help build core strength. If you have back pain, be sure to check with us before starting.
6. Don’t Avoid Going To The Doctor. Treating your back pain symptoms with ice and/or heat is a good self-care option for the short-term, but any back pain that persists longer than two weeks should be examined by a professional. A visit with your chiropractor can help determine the underlying cause and develop the most effective treatment plan to get you back to feeling yourself again.
Re-Printed via Permission of ChiroUp
Dizziness and vertigo account for over eight million primary care visits in the US each year. Disequilibrium may arise from one or multiple anatomical structures. “Central” origins include the brain stem, cerebellum, or other supratentorial structures (or the vasculature supplying those tissues). “Peripheral” origins include the vestibular, visual, and spinal proprioceptive systems.
The most common cause of vertigo is from a peripheral source: the cervical spine. Proprioceptive input from the cervical spine plays a critical role in the maintenance of balance. Most researchers ascribe to an altered “mechanoreceptive” theory as the origin to cervicogenic vertigo. The upper cervical (C0-3) facet joints are highly innervated, supplying up to 50% of all cervical proprioceptive input. Abnormal stimulation of the articular capsule and muscle spindle mechanoreceptors from joint dysfunction or muscle hyperactivity provides conflicting input with visual and vestibular afferents. This sensory mismatch between visual, vestibular, and cervical mechanoreceptive input “confuses” the brain into a temporary state of dizziness.
New research from Peng (2018) implicates cervical spine degeneration as a trigger for vertigo.
“Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in hypertonic neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness.” (1)
True cervicogenic vertigo typically responds to chiropractic manipulation, myofascial release, and rehab exercises. These patients are often home runs that would otherwise fail medical management. Medicine may be a good treatment option for many chemical problems, but cervicogenic vertigo is a mechanical problem.
Shoulder pain is one of the most common presentations in a chiropractic office. This malady is responsible for nearly 5 million physician visits each year. Contrary to public opinion, there is no rotator cuff fairy that randomly taps a patient on the shoulder with lasting gifts of dysfunction and pain. Years of repetitive strain, sports, traumas, and poor posture are the primary contributors to shoulder dysfunction. Rotator cuff problems almost always begin with scapular dyskinesis, then anterior impingement syndrome, and eventually progress to rotator cuff syndrome if the causative factors are not corrected. This degenerative cascade affects the shoulder in a very predictable pattern. The only variable is the date at which the patient develops symptoms. Luckily there is ONE critical contributor that all chiropractors can address in the treatment of shoulder pain.
Yamamoto et al. (2015) studied a cohort of 525 participants without shoulder pain. Then, using ultrasound, his team identified those patients with asymptomatic rotator cuff tears; 24.5% showed a tear in one shoulder, and 11.9% had tears in both. (1) Yamamoto then subdivided this population into four groups based on their postural classifications as defined by Kendall.
(2) The researchers correlated each posture to the likelihood of rotator cuff tear and found that postural abnormalities are an independent predictor of rotator cuff tears.
“Prevalence of rotator cuff tears was 2.9% with ideal alignment, 65.8% with kyphotic-lordotic posture, 54.3% with flat-back posture, and 48.9% with sway-back posture. Logistic regression analysis identified increased age, abnormal posture, and past pain as factors associated with rotator cuff tears. It is difficult to conclude whether postural change represents a primary or secondary phenomenon due to rotator cuff tear. However, patients with ideal posture experience rotator cuff tears relatively rarely, so keeping the spine in ideal alignment would appear helpful as a measure for preventing rotator cuff tears as well as in rehabilitation therapy for shoulder disorders.” (1)
Based on our understanding of scapular mechanics and upper crossed syndrome, it is logical to conclude that posture is a risk factor for developing rotator cuff tears. This paper demonstrates the importance of correcting posture in four steps:
Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.
A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck).
One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?
This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”).
The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord.
This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.
Cliff Atwell, B.S., D.C.