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 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 doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.
Is there a “normal” or “best posture” out there? If so, what is it?
Posture is largely inherited; however, there are also environmental, social, and other forces that can affect posture. Some say “good posture” is the position that places the least amount of strain on the body, particularly the muscles and ligaments that hold the body together.
A common cause of poor posture is called forward head carriage (FHC), where the head sits forward of the shoulders, placing a greater strain on the back of the neck and upper back to hold the head upright. Looking at the spine from the side, the opening of the ear should line up with the shoulder, hip, and ankle.
There have been studies that suggest every inch (2.54 cm) of FHC increases muscle strain in neck and upper back by 10 pounds (4.5 kg). That means a 5 inch (~12.7 cm) FHC adds an extra 50 pounds (~22.7 kg) of strain on the neck and upper back to hold the head upright. So what can we do to improve our posture?
First, stay active to reduce the normal rate of degeneration that affects us all as we “mature” through life! This recommendation requires us to keep fit and strive to maintain a normal BMI (“body mass index” or weight/height ratio) by balancing calorie intake and exercise.
Now, besides being evaluated for specific spinal care, there are a couple exercises you can do to help improve your cervical posture:
EXERCISE #1 is called a chin tuck. Here, you simply pull your chin inwards, producing a “double chin.” If you do this as far as you can and talk your voice will sound funny (“nasal-like”). Release the tuck until your voice clears. The moment it clears, STOP – that’s your “new” head position. Try to maintain that all day. You will have to remind yourself to “…keep it tucked” frequently at first but as time goes on, it will feel more natural. This can take about three months on average, so BE PATIENT!
EXERCISE #2 will strengthen the deep neck flexor muscles by doing the exact same thing as exercise #1 BUT adds a hand, a towel, or a TheraBand (anything works) for resistance behind the neck so that as you chin tuck, you PRESS the back of your mid-neck into your finger tips (or Band, towel, etc.) and hold for five seconds (then, release slowly). Do this five, ten, or multiple times a day.
There are other exercises but this is a GREAT start! See your doctor of chiropractic for more specific individual needs!
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 neck pain or headaches, we would be honored to render our services.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Neck pain is very common! According to one study, between 10-21% of the population will experience an episode of neck pain each year with a higher incidence rate among office workers. Between 33-65% will recover within one year, but most cases become “chronic, recurrent” meaning neck pain will come and go indefinitely. The more we can learn WHAT to do to prevent these episodes, the better.
1. SLEEP: Use a cervical pillow so the NECK is fully supported during sleep. This keeps your head in alignment with your spine. Also, if possible, sleep on your back!
2. OFFICE: Position the computer screen so that it’s at or slightly below eye level and straight in front of you. The “KEY” point is that you feel comfortable with the height of the monitor. Keep your chin “tucked in” so the 10-11 pound (4.5-5 kg) weight of your head stays back over your shoulders—this will place less of a load on your upper back and neck muscles to hold your head upright! Set a timer on your cell phone to remind you to get up and move around every 30-60 minutes.
3. TELEPHONE: If you are using the phone a lot during the day, GET A HEADSET! If you are pinching the phone between your shoulder and ear, you WILL have neck problems!
4. EXERCISE: Studies show people who are more physically active are less likely to report neck pain.
5. NUTRITION: Search for information on the “anti-inflammatory diet.” It’s basically fruits, veggies, and lean meat, with a few other twists. Also, stay hydrated by drinking plenty of water each day.
6. LIFT/CARRY: A heavy purse, brief case, or roller bag can really hurt your neck. Take ONLY what you need and put the rest in a secondary bag that stays in your car or where you can access it when needed. Switch to a backpack if possible vs. a heavy brief case.
7. SELF-MASSAGE: Reach back and dig your fingers into your neck muscles and “work” the tight fibers back and forth until they loosen up. Roll your head over the top edge of a chair by sliding down until the top of the chair back rests in your neck. Search for the tight fibers and work them loose!
8. WHIPLASH: If you are injured, DO NOT WAIT! Those who seek chiropractic care shortly after an accident have less long-term trouble!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
There are approximately 113 different cannabinoids that have been isolated from cannabis, and those that have been studied exhibit a variety of effects(1). In the marketplace, we have access to about six: THC, CBD, THCa, CBDa, CBN, and CBG. As technology improves and companies mature, new products featuring additional cannabinoids are beginning to become available, including products with delta-8 THC, THCv, and CBC.
The cannabinoids that have the suffix –a are called acidic cannabinoids. When acidic cannabinoids are exposed to heat or to prolonged light, they convert to an activatedcannabinoid. For example, THCa and CBDa are acidic cannabinoids, while THC and CBD are activated cannabinoids. This conversion process is called decarboxylation. Why should you care about decarboxylation? Because—while there are some overlapping therapeutic properties—some of the acidic forms of cannabinoids can have very different effects than their activated counterparts.
There is currently limited scientific information on the pharmacology and toxicology of the acidic cannabinoids. This blog will focus on CBDa, and the data that is available suggests that CBDa might be effective at treating the following conditions:
Nausea and Vomiting
A 20112 and a 20133 study both demonstrated that CBDa reduces vomiting and nausea (in fact, these studies—both done in rat models—suggested that CBDa was more effective than CBD in controlling nausea and vomiting). CBDa is also effective at treating anticipatory nausea and vomiting, which is a condition of psychological nausea and vomiting and is believed to be a learned response to chemotherapy4.
To date, there are no completed human or animal studies to test whether CBDa is a treatment for inflammatory conditions. However, research in cell cultures demonstrates that CBDa is a COX-2 inhibitor and might have similar effects as non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, acetaminophen, and aspirin, which are often prescribed for inflammatory pain.
Long-term and heavy use of NSAIDS, however, can lead to stomach ulcers, kidney damage, high blood pressure, and headaches, mostly because many NSAIDS are both COX-2 and COX-1 inhibitors. Cox-1 inhibitors also reduce inflammation, but data suggests that COX-1 inhibitors decrease the protective mucus lining of the stomach, causing stomach problems, intestinal bleeding, and ulcers. CBDa is not a COX-1 inhibitor.
COX-2 activity is involved not only in inflammatory processes but also in the metastasis—or spreading—of cancer cells. Research suggests that the regular consumption of COX inhibitors might lower the rates of cancer, especially for colorectal cancer5. Research suggests that CBDa, as a COX-2 inhibitor, might reduce cancer cell proliferation, promote the natural death of diseased cells, and reduce the blood supply required for tumor growth6.
For example, a study publish in 2012 demonstrated that CBDa inhibits migration of a specific type of invasive breast cancer cell7, preventing these cancer cells from growing and dividing. And a study published in 20148 demonstrated that CBDa slowed down the spread of cancerous cells, which is especially critical in breast cancer, where metastases are responsible for 90% of breast cancer-related deaths9.
Of course, like all cannabinoids, CBDa can have side effects, though they are generally well-tolerated and dose-dependent. And, again, there exists limited scientific information on the pharmacology and toxicology of CBDa. However, based on patient feedback—and assumptions about the similarities that CBDa shares with CBD—we can expect CBDa to have side effects that include anxiety, jitteriness, diarrhea, and increased heart rate, and decreased appetite. Also, CBDa can inhibit or potentiate other medications.
Some patients find relief by juicing raw cannabis flowers that are high in CBDa. Patients can also find CBDa in tinctures and oils, which they can consume orally or use topically. Finally, there are some products that contain CBDa isolates, which means that they product was processed to remove all other cannabinoids. As with all acidic cannabinoids, it’s a good idea to keep CBDa refrigerated to prevent it from converting into an activated cannabinoid.
Many patients find that CBDa can be a potent natural pain reliever without the risk of ulcers or kidney damage. Radicle Health patients have reported that CBDa reduces inflammation, pain, and fatigue, and other patients have reported improvement with ADHD and with cognition. Also, CBDa does not cause the type of euphoria associated with THC, so patients can use CBDa during the day without any impairing side effects. As always, ensure that you work with a cannabis healthcare professional to determine which cannabinoids and which products are right for your condition or disease.
2“The effects of cannabidiolic acid and cannabidiol on contractility of the gastrointestinal tract of Suncus murinus,” Archives of Pharmacal Research, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21975813
3“Cannabidiolic acid prevents vomiting in Suncus murinus and nausea-induced behaviour in rats by enhancing 5-HT1A receptor activation,” British Journal of Pharmacology, 2013 Mar; 168(6): 1456–1470, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596650/
4“A comparison of cannabidiolic acid with other treatments for anticipatory nausea using a rat model of contextually elicited conditioned gaping,” Psychopharmacology, August 2014, http://www.ncbi.nlm.nih.gov/pubmed/24595502
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.”
Review the latest news:
Magnesium relieves migraines
Exercise vs. manipulation for SI dysfunction
Cupping carpal tunnel syndrome
Glucosamine & chondroitin for TMD
Exercise rivals shoulder surgery
1. An umbrella review of 2048 papers found strong evidence that magnesium supplementation(400-600 mg/ day) reduced the intensity and frequency of migraine. Veronese N et al. Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies. Eur J Nutr. 2019 Jan 25. doi: 10.1007/s00394-019-01905-w. [Epub ahead of print]
2. “Upper limb nerve tension (ULNT) tests are useful for ruling out cervical radiculopathy. The combined use of all four tests shows a sensitivity of 0.97. “Koulidis K et al. Diagnostic accuracy of upper limb neurodynamic tests for the assessment of peripheral neuropathic pain: A systematic review. Musculoskelet Sci Pract. 2019 Jan 12;40:21-33. doi: 10.1016/j.msksp.2019.01.001. [Epub ahead of print]
3. A double-blind trial of 44 patients found that for treating cervical radiculopathy, both active (self-flossing) and passive (in-office) neural mobilization are equally effective. Ayub A et al. Effects of active versus passive upper extremity neural mobilization combined with mechanical traction and mobilization in females with cervical radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil. 2019 Jan 11. doi: 10
4. A study of patients with chronic lateral epicondylalgia found that scapular muscle strengthening improves pain, pain-free grip strength, functional outcome, muscle strength, scapular position, and muscle activity. Sethi K et al. Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia. J Orthop Sci. 2018 Sep;23(5):777-782. doi: 10.1016/j.jos.2018.05.003. Epub 2018 Jun 28.
5. “Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with sacroiliac joint dysfunction (with manipulation showing earlier results). However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.” Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61.
6. Twenty minutes of daily “early subthreshold aerobic exercise appears to be an effective treatment for adolescents after sport-related concussion.” Leddy JJ, Haider MN, Ellis MJ, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online February 04, 2019. doi:10.1001/jamapediatrics.2018.4397
7. A study of 56 hands with CTS found: “Incorporation of cupping can reduce the severity of symptoms and improve the distal sensory disturbance of the median nerve.” Mohammadi S et al. The effects of cupping therapy as a new approach in the physiotherapeutic management of carpal tunnel syndrome. Physiother Res Int. 2019 Jan 29:e1770. doi: 10.1002/pri.1770. [Epub ahead of print]
8. “Open-chain hip abduction and single-limb support exercises appear to be effective options for recruiting the individual gluteus medius segments.” Here are a couple of very useful open-chain gluteus medius exercises: Advanced Clam and Side Plank with Abduction. Moore D et al. Rehabilitation Exercises for the Gluteus Medius Muscle Segments – An Electromyography Study. J Sport Rehabil. 2019 Feb 12:1-14. [Epub ahead of print]
9. Glucosamine and chondroitin sulfate are effective in treating TMJ disorders. (The typical dose is 1500mg Glucosamine and 1200mg Chondroitin/ day) Ganti S, Shriram P, Ansari AS, Kapadia JM, Azad A, Dubey A. Evaluation of Effect of Glucosamine-Chondroitin Sulfate, Tramadol, and Sodium Hyaluronic Acid on Expression of Cytokine Levels in Internal Derangement of Temporomandibular Joint. J Contemp Dent Pract. 2018 Dec 1;19(12):1501-1505. PubMed PMID: 30713180.
10. Despite being one of the most common orthopedic surgeries performed, subacromial decompression is notsignificantly better than exercise therapy to treat patients with pain and limited function caused by shoulder impingement. Shaughnessy AF. Decompression Surgery No More Effective Than Exercise for Shoulder Impingement Syndrome. Am Fam Physician. 2019 Feb 1;99(3):190.
11. HVLA Beats Exercise for Chronic Neck Pain: “Although both interventions were associated with immediately improved ROM and pain after treatment, HVLA manipulation was more effective than craniocervical flexion exercise in improving ROM and VAS (for chronic neck pain patients)”. Galindez-Ibarbengoetxea X, Setuain I, Ramírez-Velez R, Andersen LL, González-Izal M, Jauregi A, Izquierdo M. Immediate Effects of Osteopathic Treatment Versus Therapeutic Exercise on Patients With Chronic Cervical Pain. Altern Ther Health Med. 2018 May;24(3):24-32.
A three-year study found that many patients with a degenerative spinal disease can avoid surgery through conservative treatment…like the type provided by our office.
If you or someone you know suffers from back pain, don’t delay & call our office today! We will define a plan to help get you back to the life you love.
Learn more about how chiropractic treatment can help resolve your back pain by clicking here:
Source: Demir-Deviren S et al. Comprehensive non-surgical treatment decreased the need for spine surgery in patients with spondylolisthesis: Three-year results. J Back Musculoskelet Rehabil. 2019 Jan 11. doi: 10.3233/BMR-181185. [Epub ahead of print] http://bit.ly/2V5tsGj
We all know what it’s like to have neck pain—whether it’s after a long drive, pinching the phone between the head and shoulder, star-gazing, or from talking to someone who is seated off to the side. There are many causes of neck pain, but the question of the month is, how do chiropractic adjustments help neck pain? Let’s take a look!
Chiropractic, when broken down into its fundamental Greek derivatives, means “hand” (cheir) and “action” (praxis). The technique most often associated with chiropractic is spinal manipulation where a “high velocity, low amplitude” thrust is applied to specific vertebrae in the spine, which does several things: 1) It restores mobility in an area with restricted movement; 2) It stimulates the sensory “neuroreceptors” in joint capsules, which has a muscle relaxing reflex effect; 3) It can affect surrounding neurological structures in certain parts of the spine such as the parasympathetic (cranial & sacral regions) and sympathetic (mid-back) nervous systems, which can have beneficial effects on the digestive system, cardiovascular system, and other body systems not typically thought about when seeking chiropractic care.
Joint manipulation is not new, as it can be traced back to as early as 400 BCE. The profession of chiropractic began in the later 1800s and has grown in popularity ever since. There is now an overwhelming body of evidence that supports spinal manipulation as both a safe and highly effective treatment for neck and back pain, headaches, and many other maladies.
It’s important to note that there are many different types of manual therapies that chiropractors utilize when caring for neck pain patients. There are “low-velocity, low amplitude” or non-thrust techniques that do NOT produce the “crack” that is frequently associated with chiropractic adjustments. The term “mobilization” is often used when referencing these non-thrust methods, and this often incorporates a combination of manual traction (pulling of the neck), left to right and front to back “gliding” movements usually starting lightly and gradually increasing the pressure as tolerated. In many cases, a doctor of chiropractic may utilize a combination of manipulation and mobilization as well as “trigger point therapy” (applying sustained pressure over tight “knots” in muscles), depending on a patient’s needs.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
How does CBD work?
In the last 30 years, Research on the effects cannabis on the human body led to the discovery of the ECS, or endocannabinoid system. CBD is a cannabinoid. The ECS is a complex system of cannabinoid receptors found throughout the body, but mainly in the immune and nervous systems. The ECS plays a role in communicating with, and regulating virtually every system and organ in the body. A healthy ECS enables Homeostasis, which is when our cells, organs, and physiological systems are in balance and working properly. CBD works extremely efficiently with the ECS to help maintain that homeostasis and balance across the different systems of our body. CBD helps the body heal and balance itself.
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. Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.
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.
Cliff Atwell, B.S., D.C.