Category Archives: chiropractic

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Lower back Pain Part 2

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More common conditions

Lumbar Disc Disorders

The lumbar spine is made up of five bone segments called vertebrae. In between each vertebra are flexible intervertebral lumbar discs, which act as shock absorbers for the spine. The intervertebral discs are composed of two components, a tough outer ring of fibrous tissue called the annulus fibrosis, and a jelly-like center inside the annulus fibrosis called the nucleus pulposus. The structure is then held together by ligaments on the front and the back of the vertebrae. Additional support is provided by muscles of the trunk.

In most cases, lumbar disc disease is the result of a normal aging process called disc degeneration which causes structural changes in the normal disc. As we age, the disc begins to lose fluid and become dried out causing the disc to compress. This may lead to the breakdown and degeneration of tough outer ring of the disc (annulus fibrosis) allowing the inner core (nucleus pulposus), to bulge out. This is considered a bulging disc. This puts pressure on the outer ring of the disc, which may cause low back pain. As further degeneration of the disc continues, or with continued stress on the lumbar spine, the inner jelly-like core may rupture out from the outer ring causing a ruptured, or herniated, disk. Once the inner nucleus herniates through the outer ring, pain in the lower back may improve.

However, the fragmented disc material can inflame or put pressure on the spinal nerves leading to an increase in sciatic leg pain, weakness, numbness, or changes in sensation in one or both legs. Most disc herniations occur at the lower lumbar spine at L4-L5 and L5-S1 levels. Occasionally, severe trauma can cause a normal disc to herniate or may cause an already herniated disk to worsen.

Risk Factors of Lumbar Disc Disorders

  • Age and Gender – the highest incidence in men between the ages of 30 and 50.
  • Obesity – being overweight puts added stress on lumbar discs.
  • Sedentary lifestyle – lack of exercise and poor core body strength.
  • Smoking – Smoking decreases oxygen supply to the discs causing more rapid degeneration.
  • Improper lifting – using your back muscles instead of your legs to lift heavy objects. Twisting while lifting
  • Posture – hyperlordotic lumbar curvature, anterior pelvic tilt (lower cross syndrome).
  • Repetitive activities that strain your spine – jobs that require constant lifting, pulling, bending, or twisting.
  • Frequent driving – staying seated for long periods and the vibration from the car can put pressure on your discs.

History and Symptoms of Lumbar Disc Disorders

Lumbar disc disorders may include one or a combination of the following symptoms:

  • Intermittent or constant lower back pain and pain in the buttock,
  • Leg and foot pain, numbness or a tingling sensation in the leg and foot,
  • Weakness in the leg and foot
  • Decreased reflexes in the knee or ankle
  • Changes in bowel or bladder function.

The symptoms will vary depending on if and where the disc has herniated, and what spinal nerve root is affected. Leg pain is usually greater than low back pain with disc herniations and nerve root involvement. However, if there are only annular tears without herniation, the pain will be localized to the low back and buttock. The onset of pain can be sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or straining activities or repetitive stress trauma. However, patients may not recall a prior injury or a precise time the condition began because it is often preceded by frequent episodes of less severe low back pain that usually resolved. Pain is usually characterized by sharp, shooting, or electrical pain that may be aggravated by movement, changing positions, sneezing, coughing, or prolonged sitting and standing. The pain is usually relieved with rest and a recumbent position.

Treatment of Lumbar Disc Disorders

Conservative care should be your first course of treatment to manage lumbar disc disorders, but treatment will depend on the clinical presentation, your age, overall health, and tolerance to therapies. With disc herniations, the first few days of care will focus on centralizing (reducing) leg pain, decreasing inflammation, and preventing further neurological loss by decompressing nerve root impingement and reducing the disc herniation. Osseous mobilization and manipulation and soft tissue therapy may be administered as tolerated. Home care will consist of pain-relief repetitive positional exercises and lumbar stabilization exercises. We will also educate you on ways to protect your lower back, positions to avoid, and how to manage activity. In most cases, bed rest will not be recommended as the sooner you are up and moving, the better the prognosis. Once pain and inflammation have decreased, we will continue working on lumbar stabilization and progress into proprioceptive training. We will evaluate muscle imbalances using posture and movement patterns with the goal of restoring good biomechanics and core body strength. Your home care will emphasize the progression of stabilization protocols and corrective exercises. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a referral for a surgical consultation will be recommended.

Lumbar stenosis

This condition occurs when there is a narrowing of the spinal canal in the lumbar vertebrae (low back). Often this results in compression of the spinal cord, which can lead to pain, numbness, discomfort and radiating symptoms. What the mechanism of this is occurring is usually caused by the degenerative changes of aging. However, there are other causes.

The main physical causes of this condition are:

  • Degeneration of the lumbar spine
  • Lumbar disc herniation putting pressure on the spinal cord
  • Osteoporosis
  • Dwarfism (achondroplasia)
  • Tumor

Degeneration of the spinal column is inevitable with aging and may reflect normal changes in an aging spine. It does not necessarily always result in lumbar stenosis but is often the most common cause.

While it is difficult or impossible to combat normal aging of the spine, there are some habits and tips you can use to reduce this condition related to the other causes. Reduce your chances of a lumbar disc herniation by learning proper bending and lifting biomechanics by utilizing your lifting power from your legs and not your back. As far as osteoporosis goes, make sure you are meeting your recommended calcium intake as well as incorporating weight bearing activities into your exercise routine (lifting weights). Post-menopausal women tend to be more susceptible to this condition and should ensure they are doing everything they can to prevent osteoporosis.

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Low Back Pain Part 1

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Understanding and Preventing Your Low Back Pain

About 80% of Americans suffer debilitating low back pain at some point in their life. This fact is staggering, yet it doesn’t have to be this common. The key to staying out of this group of low back pain sufferers comes down to one word: Prevention.  If I had to choose one common problem amongst all low back pain sufferers, it would be bad low back position during common activities such as brushing your teeth, bending over, picking up a small child, exercising and sitting.

The lumbar spine, which is the lower part of the spine, is meant to have a natural curve to it that displaces the forces of gravity, weight, etc. evenly and minimally. When this natural curve is straightened, or reduced, the forces on the discs, muscles, and ligaments of the low back are significantly increased. For example, sitting without maintaining the natural curve increases the forces on those structures by 30%-40%!

There are many conditions that can be covered under the umbrella of low back pain, but in this article, we will cover the following conditions for the sake of this informational handout. The keys of prevention of low back pain are as follows:

  • Understand your symptoms and risk factors
  • Body Preparation and Positioning
  • Proper Activities of Daily Living
  • Corrective Exercises
  • Treatment Considerations

Common Low Back Conditions

Lumbar strains and sprains

A lumbar strain is when an injury occurs to the muscles of the low back. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. When these muscles or ligaments become injured, it can lead to dysfunctional movements, and cause instability in the spine. Patients suffering from this diagnosis often have pain when attempting to walk, sit, exercise and can even occur during sleep.

The main physical causes of this condition are:

  • Overexertion
  • Falls
  • Poor movement mechanics
  • Poor posture
  • Heavy lifting

However, with proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing muscles. A comorbid factor of this condition is often a desk job that involves sitting for most of the day. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a strong core and training your spinal muscles cannot be overstated.

In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the detrimental effects of sitting on the spine, as well as education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.

If you are having back pain or want some guidance on how to prevent back pain please call the office. We will be happy to help!

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Mattress buying Guide

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Buying a mattress can be quite a daunting task. One of the most frequent questions I get is which mattress is the best to purchase. This blog post is designed to help you make a better decision.

There is an endless amount of options, materials, and features available making it difficult to determine which mattress is right for you.  The average adult sleeps for eight hours a night; this means that you could be spending up to a third of life lying on your mattress, making this purchase all the more important.

The first question to ask yourself is do you need a new mattress? The average lifespan of a mattress is 5-10 years. Many manufacturers will have warranties that extend beyond the 10-year range, but for most the 8-year mark is when it is time to look at replacing the mattress. However, if you wake up every morning feeling sore or with back pain that tends to resolve within 15-30 minutes of being awake, this could indicate that you should be looking to replace your current mattress.

Unfortunately, there is not a one size fits all for mattresses. Everybody has a different body type, a different way to sleep, and experiences comfort differently. Some people will require a softer mattress and others will prefer a firmer mattress. In the end, this is personal preference and very subjective. We will provide you with some general guidelines to consider when testing out mattresses but there is no replacement for going to the store and testing out different options yourself. We recommend when testing mattresses, you lie on them for at least 10 minutes as this will give you a much clearer indication to its comfort level and how your body responds to its level of support.

The Ten Minute Test

What is the ten minute test? Can you lie on the mattress for ten minutes comfortably without moving? How can you sleep on the mattress for 6-8 hours a night if you can’t lie comfortably for ten minutes? If you can’t your body is telling you something.

Another factor to consider when purchasing a mattress is whether your purchase has a comfort guarantee. Even after doing all your due diligence and testing it in the store you may notice after a couple night’s sleep you will realize the mattress you selected simply is not right for you. Some companies offer a comfort guarantee in the event you decide you are not satisfied with your mattress (typically within 30 or 90 day periods). Every guarantee is different, and some have fees associated with the return. Therefore it is important to understand the fine print associated with any specific guarantee. This guarantee will protect your purchase and ensure that you will not be spending the next eight years waking up with a sore back from sleeping on the wrong mattress.

It is also important to understand the cost associated with mattresses. Prices vary widely and range anywhere from $200 to $5000 +. Unfortunately, price does not always correlate with quality or the right mattress for you. It is recommended that you budget at least $800-1000 for your new mattress. This budget should be enough to purchase a quality mattress that fits your needs but also one that is built to last you the 8-10-year range.

Once you determine your budget the next step is to figure out which style mattress best suits your needs.

Innerspring mattress: The innerspring mattress is also known as a coil mattress. It is arguably the most traditional style of the mattress and currently one of the most common mattresses on the market. It is typically a firmer mattress style, and the individual coils can offer quality support for your back. The “coil counts” on innerspring mattresses tend to indicate better comfort and support as the number increases. With that in mind as long as you have a minimum coil count of 400 the difference in higher count mattresses is typically nominal.

Memory foam mattress: Memory foam mattresses mold to the contour of your body better than any other type of mattress.  This results in fewer pressure points when you are sleeping. These mattresses tend to be by and large a softer mattress, but that still depends on the model you purchase as some brands make firmer memory foam models.  It can also serve to absorb movement, helping decrease the disturbance of sleeping with a partner. One of the main drawbacks of a memory foam mattress is that it tends to absorb heat and can be a very hot mattress to sleep on.

Latex Mattress:  Latex mattresses tend to be firmer, with bouncy support throughout the mattress. One of the main features of a latex mattress is that the material remains cooler as the latex foam does not absorb heat the same way that memory foam does.  Latex mattresses are often considered to be a good option for a patient suffering low back pain due to their combination of softness and support. A latex mattress will also provide the same feeling of a foam surface similar to the memory foam however it the contouring of a memory foam mattress.

Pillow Top: A pillow top mattresses do not indicate a type of mattress rather, it describes the addition of soft layer sewn on top of the mattress. They can be any one of innerspring, latex or memory foam mattresses underneath the pillow top layer. This results in a softer, more cushioned top surface with a firmer base of support.

These are the main categories of mattresses, but there are many other variations on the market. One final style to consider is an adjustable mattress. These mattresses can change the firmness from firm to soft at the touch of a button. This provides you with the ability to try different levels of firmness until you find the right amount for you. Many of these beds also have adjustable bed angles which can further customize your sleep experience.

Firm or Soft mattress?

Now that we’ve discussed what styles of mattresses exist, the next step is determining whether you need a firmer or a softer mattress. Everyone’s preference is different however there are several factors that we can look at to help guide our decision.

The size of the individual sleeping on the mattress is the first important factor. If you are a lighter person, then a pillow top mattress is likely not a good fit. To maximize the pillow top, you must be heavy enough to compress the top layer to be supported by the underlying material of the mattress.

If you are a lighter individual, you will look for a softer top layer. That way you can benefit from the lower supportive layer of the mattress. Typically, the denser the top layer, the more uncomfortable a lighter person will be.

If you are a heavier individual, then you will aim for a denser top layer and a firmer mattress. This is the case where a pillow top mattress may be a good option. For heavier people who are still looking for that soft feel while they sleep, they can look at a pillow top mattress, which offers the soft cushion with a firmer coil supporting them under the top layer.

Side sleepers, Back sleepers, Belly sleepers

The next important factor in choosing your mattress style is your sleeping style. Everyone sleeps differently, from side sleepers, to back sleepers, to belly sleepers (although this is not recommended for the health of your back) everyone sleeps in a different position.

For a side sleeper, it is typically recommended that you look for a soft to the medium mattress. The mattress must be soft enough for you to sink in but also offer enough underlying support that prevents having pressure points in the back and neck. Your body has curves, and you want your new mattress to support all those curves while you sleep to eliminate any risk of soreness when you wake up.

Back sleepers, on the other hand, tend to require a medium to a firm mattress. When sleeping on your back, it is essential that the mattress offers an adequate amount of support and firmness or you will run the risk of sinking in and sleeping in a poor posture. The worse your sleeping posture is the increased likelihood that you will wake up with back pain.

Finally, stomach sleepers tend to need the most support. This sleeping position puts the spine in a vulnerable position as the slightest angle from sinking into the mattress can lead to sleeping associated back pain. Therefore, if you must sleep on your stomach, aim for a firm mattress that avoids any pressure points. If you are a stomach sleeper who constantly wakes up with back pain, we recommend trying to slowly change your sleep posture to your side or back. Although, it is never easy to make such a change often this is the best option for the long-term care for your back.

These are simple guidelines that you can use to help decide on your new mattress purchase, but it is not a replacement for physically trying the mattress yourself. Comfort is always subjective, and you will not know what your style preference is until you try one for yourself.  Remember to take your time and test as many options as possible, not only is it a financial investment but it is also an investment in your long-term health and well-being.

https://www.mattressnerd.com/mattress-buying-guide/ https://sleepopolis.com/guides/how-to-choose-a-mattress/ https://www.consumerreports.org/cro/mattresses/buying-guide/index.htm

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Lifestyle factors can effect mortality and life expectancy

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Who doesn’t want to live longer? I bet almost everyone would take the opportunity to live longer if they could. Did you know adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults?

The things we do every day can influence how long we live. So do we have to do some bio hacking or a super detox to live longer? Fortunately it much easier then that. Simple things can improve our health and make us live longer. So what are they?

  • Never smoking ( that was easy right?)
  • Regular physical activity! This can include walking or lifting weight.
  • Healthy diet. Mom said eat your vegetables and you’ll be healthy. She was right. Maintain a normal BMI. Obesity will lower how long you can live.
  • Moderate alcohol consumption. Less consumption the greater improvement in health.

Doing these thing can prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults

See you don’t have to become a vegan or run ultra marathons to improve your health and live longer. The one thing I would add is make sure you are sleeping 7-8 hours a day. Lack of sleep can effect you negatively.

If you need help jump starting a healthier lifestyle call the office. I can help!

Here’s the study. Lots of great graphs and details. https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.117.032047 Conclusion of the study: Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.

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Windlass mechanism

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Windlass mechanism

At heel strike, the plantar fascia is slack to allow the foot to accommodate uneven surfaces. As the heel lifts and forefoot dorsiflexes toward toe-off, the distal plantar fascia “winds” up and around the first MTP joint pulling the plantar fascia taut, shortening the distance between the heel and forefoot, raising the arch– creating a stiffer lever for propulsion. (10)

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Can chiropractic adjustments help shoulder impingement syndrome?

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Shoulder Impingement Syndrome is a common condition that we treat all the time. When treating non traumatic shoulder impingement syndrome/shoulder pain, looking for the reason or areas in and around the shoulder that could be adding to the problem will help with healing the patient faster. One area that can contribute to shoulder dysfunction is the thoracic spine. Sitting in front of a computer all day can cause decreased mobility in the neck and upper back. If theses areas aren’t working correctly they can cause increased stress in other areas such as the shoulders.

In the study below the researches found improving thoracic spine mobility was beneficial in the treatment of shoulder impingement.

“It is beneficial to include treatment to increase thoracic spine mobility within shoulder impingement syndrome management.”

Meadows S, Smith G, Vaswani R. Physiotherapist survey: Increasing thoracic spine movement within the management of chronic subacromial impingement syndrome. Journal of Bodywork and Movement Therapies. 2020 Jan 1;24(1):93-9. Link

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Can bad posture effect how your nervous system works?

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Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control?

Forward head posture can lead to many things! Besides looking bad it can cause such things as headaches, neck pain, shoulder pain as well as TMJ problems.

Highlights from the study show:

  • Forward head posture negatively affects cervical sensorimotor control.
  • Forward head posture negatively affects the autonomic nervous system.
  • There is strong correlation between the Craniovertebral angle (CVA) and cervical sensorimotor outcomes.
  • There is strong correlation between the Craniovertebral angle (CVA) and cervical sensorimotor outcomes.
  • There is strong correlation between the Craniovertebral angle(CVA) and skin sympathetic outcomes.

Here’s a picture of forward head posture or a poor CVA. The picture to the left is the worse CVA. The one on the right is very good posture.

text neck
the picture

CONCLUSION:

“We have identified a forward head posture is associated with abnormal autonomic nervous system function and disturbances of cervical sensorimotor control. This finding has important implications for the assessment and rehabilitation of these subjects.”

If you need help with your posture contact the office! We can help!

https://www.sciencedirect.com/science/article/abs/pii/S0966636220300059?via%3Dihub

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When Is Standing Too Much?

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The new craze in standing at your desk has many asking if standing is for them, and how long should they stand for? Does everyone need a standing desk?  Not everyone needs a standing desk.  If you do have pain with sitting and  you sit for your job, then a sit to stand opinion might be for you.  Below are some tips to make the transition from sitting all day, to using a sit to standing desk without hurting yourself.

  • Standing too much can cause low back pain and leg pain.
  • Body is designed to sit and stand throughout the day. There are many ways to get your standing throughout the day without the need for a sit-to-stand option.
  • Sit-to-stand options can be useful and make the ability to stand more readily available. If you do have this options, here is what you need to look out to ensure proper utilization.
    • Most start at 15-20 mins within the hour in the beginning then it grows.
    • 4-6 hours per day after 30 days.
    • Start off slowly- taking breaks.
    • Listen to your body.
    • Flat surface and flat shoes (no heels!)
    • Weight distribution right below hips and arms at a right angle looking straight ahead and slightly down.
    • Don’t do continuous 8 hours of standing.  

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How do shoes effect development of motor skills in children?

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New research published in Frontiers of Pediatrics found that children and adolescents who spend most of their time barefoot develop motor skills differently from those who habitually wear shoes. 👟 Further, they found the habitually barefoot children had noticeably better jumping and balancing skills compared to those who wore shoes habitually.

Walking barefoot not only has influences on developing proper biomechanics, but also has great influences on the brain 🧠. Walking barefoot allows for greater sensory afferentation to the brain, from the feeling of grass between their toes to balancing on pebbled sidewalks.

Try to give your young children enough time without shoes!

Zech, Astrid, et al. “Motor skills of children and adolescents are influenced by growing up barefoot or shod.” Frontiers in pediatrics 6 (2018): 115.
https://doi.org/10.3389/fped.2018.00115

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What Pillow should I get?

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Are you Sleeping on the Right Pillow?

Determining the right pillow is a personal choice that a person will make every so often. When it comes to thinking about sleep equipment, most people solely focus on the mattress. The mattress is one of the most important sleep equipment you will buy, but when it comes to sleep quality pillows are just as important. How you lay your head when sleeping plays a huge role in determining the type of support you need. Pillows not only impact the quality of sleep but can prevent any neck discomfort.

Why Does Your Pillow Matter?

A proper pillow will facilitate a good night’s sleep without you waking up at night or waking up with pain or a stiff neck. Having the wrong pillow over time can exacerbate unnecessary neck pain. There are a few factors that go into making a guide for yourself to determine the proper pillow for you.

Back Sleeper:

Sleeping on your back might appear to be comfy, but will highlight the underlying issue of snoring if you have a pillow that allows your head to sink. As you lay your head back, gravity will push the tongue back and block your throat. A better alternative will be a pillow that offers height, neck support and keeps the throat at a comfortable level.

Side Sleeper:

One of the most common positions to sleep in is on the side. You will need more support to keep the neck at a neutral angle.

Stomach Sleeper:

Sleeping on your stomach might be comfortable for a few nights, but after a while can become taxing on your back and neck. However, having the right pillow can negate some of these issues. A firm/plump pillow will force your neck into an odd angle that might lead to some discomfort. A better alternative would be a softer option.

When Is It Time To Replace Your Pillow?

On average, a pillow should be replaced every 18 months. The old age rule “ you pay for what you get” applies to this transaction. A higher quality pillow will last longer than an inexpensive option. Something you can do to your pillow to see if you need a new one is, take it out of the pillowcase to see if there are any stains or fold it in half and see if the pillow stays folded. If either of these are a yes then it is time to replace your pillow.