I have ordered a lot of MRIs during my chiropractic career. I have order less as I progressed thru my years of practice. I have found that most people will have some changes on an MRI. The most common finding includes, arthritis, disc bulging and disc hernation.
If your over 40, good chances that you’ll have some changes/finding on an X-Ray of MRI. I can only think of two recent patient that had no finding on their MRI.
Does a finding on an MRI mean it’s the pain generator? No, it does not. As a doctor we should treat the person in front of us and not an image.
If the symptoms warn it or patient fails to progress at all, then advanced imaging might be needed. The most common advanced Image is an MRI. Magnetic Resonance Imaging (MRI) is a non-invasive imaging technology that produces 3d images of the body.
Here a great study that showed most people have finding and asymptomatic
“We performed MRI examinations on 98 asymptomatic people. The scans were read independently by two neuroradiologists who did not know the clinical status of the subjects. To reduce the possibility of bias in interpreting the studies, abnormal MRI scans from 27 people with back pain were mixed randomly with the scans from the asymptomatic people.”
“On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”
So, if you have finding on a MRI and are having symptoms. maybe the pain is coming from the finding or maybe it not. The important thing is to treat the person as a whole and not just a finding.
N Engl J Med. 1994 Jul 14;331(2):69-73. Magnetic resonance imaging of the lumbar spine in people without back pain. Jensen MC1, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS.
Chest or stomach breather? How an altered breathing pattern causes pain
The way you breathe impacts you from a muscle and joint perspective. Poor breathing mechanics can lead to neck pain, core stability issues, low back pain, and other issues. Who knew that a simple in-out process could be so complex?
Normal breathing, also known as lung ventilation, is an automatic and seemingly effortless action. Breathing involves inspiratory (breathing in) expansion and expiratory (breathing out) contraction of the rib cage. The act of normal breathing has a relatively constant rate and volume, or amount of air that enters the lungs.
However, breathing is a coordinated effort! The act of breathing requires our lungs to expand as well as a series of coordinated muscle efforts. Starting from the chest wall, the rib cage, movement of large and small muscles, nerve signaling, ligament stretch, and even the spine.
Although we often think of our lungs as being within our chest, the top of our lungs extends quite high: almost to the very base of our neck and shoulders.
When breathing issues arise and the lungs aren’t the cause, other sources like the muscles and bones must be taken into consideration. In medical literature, the term “dysfunctional breathing” refers to a group of disorders: paradoxical breathing (upper chest breathing), erratic breathing, breath holding, and breathing too deeply or erratically (hyperventilation syndrome).
For this article, we will focus on the first: paradoxical breathing. While these disorders can create significant oxygenation deprivation problems, the focus of this article will be on the biomechanical effects of poor breathing mechanics.
It is important to assess breathing mechanics to determine if someone is using the appropriate muscles to engage in this vital task. Breathing is a complex activity involving the rib cage, joints of the spine and ribs, ligaments, connective tissues, muscles, and the lungs.
Breathing performance is drastically affected if one or more of these structures are injured, damaged, or otherwise unable to work properly. One such common condition is upper chest breathing.
What is chest breathing?
Paradoxical breathing, or chest breathing, is a sign that you aren’t breathing properly. Chest breathing refers to chest, midback, and lower neck muscles that become overworked due to poor biomechanics.
Normal breathing involves expansion and contraction of the rib cage with our breath. Breathing also uses the diaphragm, a dome-shaped muscle located at the base of our rib cage below the lungs and heart. The diaphragm is a major muscle mover that works with the lungs to inhale and exhale.
During inhalation, the lungs expand, and the diaphragm pushes down to make room for the lungs to expand with air. This presses the rib cage outward. During exhalation, the diaphragm muscle moves up to its starting position, which helps move air out of your lungs and brings the ribs inward.
During paradoxical breathing, this action is reversed. During inhalation the lungs still expand but, the diaphragm contracts. During exhalation, the lungs relax, but the diaphragm expands.
As a result, the chest and lower neck muscles become overactivated. This targeted group of muscles work together to compensate for the diaphragm. They help inflate the lungs by pulling on the rib cage to expand the upper portion.
These extra, or accessory breathing muscles in the chest and lower neck still have their own responsibilities to perform as they help with our breathing activity. The result is tight, achy muscles that aren’t effective at either job. The upper back and thoracic spine may also become stiff due to poor muscle engagement from the diaphragm, resulting in muscle tightness. Sometimes, this can even extend into the low back!
By itself, chest breathing is not necessarily a bad or pathological condition. Certain scenarios are noted for chest breathing: some examples include a sudden sprint across a lawn or a pang of anxiety while taking a test. However, when chest breathing becomes our normal method of breathing, the result is the upper chest expanding and contracting with each breath while the abdominal area does not function properly. The diaphragm is not used well during chest breathing.
What can happen from chest breathing?
Chest-focused breaths tend to be short and quick. Chest breathing uses only a small portion of the lungs and delivers a relatively minimal amount of oxygen to the bloodstream. The result is poor oxygenation to the body’s soft tissues.
In addition, excessive chest breathing causes the muscles of the chest, neck, upper back, and lower back to work too much. This can lead to tightness and strain to these areas due to overuse. The muscles become tight and ropy to the bare eye.
Chest breathing is a form of diaphragmatic dysfunction that can have many causes including trauma to the chest wall, mineral deficiencies, weak respiration muscles, sleep apnea, and nerve injury.
Symptoms of chest breathing can include:
Frequently waking up at night
Shortness of breath
Excessive sleepiness that doesn’t respond to additional sleep
Diminished or poor exercise performance
Muscle soreness in the neck and chest
Abnormally fast breathing
Poor posture in the upper back
Rounded shoulder posture
Tight musculature along the front of the neck
Do I have chest breathing?
Maybe. Here is a simple test and exercise you can do at home to improve your breathing.
Description: Breathing test to assess if patient is a stomach breather or chest breather. How to perform:
Lay on a comfortable surface on your back with your knees bent.
Place one hand on your chest and the other hand on your stomach.
Take 5 normal deep breaths and take notice of your breathing.
Up to 80% of breathing should come from the belly rising and falling; 20% should come from the chest rising and falling.
Chest breathing is more dominant than belly breathing when the belly barely moves. Here, the upper chest expands more than the abdomen, and the shoulders elevate towards the ears during inspiration. Excessive chest breathing causes overuse of the neck musculature and can lead to pain syndromes in the neck, shoulders, and upper back.
Here is a video from our friends at ChiroUp you can reference for proper breathing patterns initiated at the abdomen:
How can I learn more about changing my chest breathing?
There are a few quick exercises you can perform to help begin retraining your diaphragm and other breathing muscles to work effectively. Here’s a common one:
Corrections for Chest Breather:
Place a light book over the stomach and focus on elevating and lowering it during inspiration and expiration.
Lay on back.
Push belly outward.
Pull belly button down towards floor.
Repeat ten repetitions for two sets.
If your chest breathing has occurred over time or because of trauma, nerve injury, or other causes, other interventions may be required. It is not uncommon to manage this condition with targeted exercises, postural improvements, and even changes to your workplace setup to help proper muscle function.
How we address chest breathing
Our goal is to not only provide you with the correct diagnosis of your breathing pattern, but also determine the underlying root cause and create an individualized treatment plan specifically for you. We have many tools in our toolbox to conduct an effective evaluation and create an appropriate treatment.
Conservative care is a keystone for our Boca Raton Sports Chiropractic practice. We have many treatment options for you!
A few ones include specific stretches for muscles and tendons of the affected muscle, joint mobilization of the thoracic spine near the ribs, tendon loading and specific exercises to strengthen the surrounding muscles, hands-on soft tissue work into muscles, changes in exercise routine or modifications at work or at home, home exercise and stretching programs, and more.
All of these depend on if your chest breathing is caused by poor biomechanics of the muscles and joints. If your chest breathing is caused by mineral deficiencies, we may need to co-manage your care with a primary physician or specialist to determine the best course of action to address the root cause.
If there has been trauma to the chest wall, such as a motor vehicle accident, a full examination is imperative and may require imaging. The best way to determine your treatment approach is to make an appointment in our office for a full evaluation.
If you are dealing with poor exercise performance due to chest breathing, muscle tightness of the chest wall, upper back, or neck, excessive daytime sleepiness, or other symptoms of chest breathing, give us a call. We are happy to evaluate you and often can provide you with a same-day examination.
Companies adopting the “standing at your desk” culture want to create an active workspace which is more collaborative and productive. This type of work environment is very attractive to a new generation who actively hedge against the burdens of disease later on in life.
To clarify, there is a difference between voluntary standing at your desk culture and occupational standing jobs. The former is clearly voluntary, and the employee can sit down when stressed. The latter makes it mandatory to stand at your desk for the duration of your work.
A study by the American Journal of Epidemiology found that workers who stand for long periods of time were at a higher risk of heart disease compared to their seated counterparts.
This means that even standing should be done in moderation at work.
For you to benefit from the “standing at your desk” culture, avoid common mistakes like pushing yourself to stand for long. You don’t have to stand all day to stay healthy. Start with 15 to 20 minutes a day and build up to two hours a day then four hours. They are called sit/stand desks for a reason, because you can adjust them to accommodate you when you are seated or standing.
To make it more bearable, you can play some music or interact more with your colleagues.
Also, makes sure the desk is the right height. If it’s too short you’ll ruin your posture but too high and you will feel it in your neck and arms. The correct position is having your elbow no more than 90 degrees and your eye line directly opposite your computer screen or just below.
On top of that, you want to pay attention to your posture to eliminate the chances of lower back pain. The right posture creates an S-curve to your spine. Using a standing mat gives you more comfort on the balls of your feet and reduces fatigue to the legs.
Experts recommend standing for 30 minutes per hour in order to get the type of health benefits you are looking for. This approach gives you half an hour of rest and half an hour standing to strike the best balance.
Some people believe that you don’t need a sit/stand desk to stand regularly. They believe that water and coffee breaks, bathroom breaks, and moving from one department to another to interact with a colleague provide plenty of standing opportunities to promote good health.
However, with the presence of phones and e-mails, we rarely have to get off our chairs at work to go and ask a colleague a question in person. Besides, how many bathroom breaks do you take? According to the Society for Human Resources Management, you can use the standing desk to promote an active workforce without relying on snacks and bathroom breaks to fill the gaps.
Finally, for the standing at your desk culture to succeed, there has to be a commitment to the initiative from the top down.
For example, it’ll be very difficult to encourage staff to stand at their desk or even use the trendy workstations with bicycles or treadmills attached when the managers never go near those things. After all, no one wants to seem like they are exercising when they should be working.
When an office decides to go down the path of an active working environment, everyone should be involved. Remember: standing desks are a powerful investment in employee wellness and health.
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.
The flat surface and flat shoes (no heels!)
Weight distribution right below hips and arms at a right angle looking straight ahead and slightly down.
I treat a lot of lower backs. Many times the cause of the pain is from moving incorrectly. Bending or twisting wrong 10,000 time can lead to acute pain, much like a fall or car accident can.
Half of my job as a chiropractor is teaching patients how to move and use their body correctly again.
The following information is from a great book meant for the non-physician to help resolve their own back problems. The book is by Stuart McGill PhD and is called “Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you.”
I highly recommend this book if you have suffered or are currently suffering from low back pain. I have taken multiple classes from him. A lot of what I teach patients comes from his research. The end goal is to remove the stressors and spare your spine with proper movement and strengthening exercises.
“Many back pain sufferers would experience a huge breakthrough in their recovery if they only realized that is was their flawed movement patterns that kept them pain-sensitive. Much like a scab forming on our skin, our backs are constantly trying to patch and health themselves. We, however, by continuing to repeat harmful movement patterns in our daily lives cause re-injury. We are essentially “picking the scab.” It is unreasonable to expect the body to heal if we continue to provoke it in the same way that led to the original injury. Continued provocation of pain sensitizes the nerves so that the pain is triggered with even less stimulation. Remove the provocative motions and we can find the solution.
Here’s how pain sensitivity works: people increase their sensitivity through repeated stressful and painful loading. These muscles and joints are loaded with sensors: pain sensors, pressure sensors, force sensors, chemical sensors. Some detect carbon dioxide; some detect pain, some sense histamine for inflammation. Human joints are packed with sensors that relay position and movement information to the brain. These signals travel along the sensory nerves. Along the highway of nerves, there are checkpoints or “gates,” at junctions. According to the Gate Theory of Pain, the idea is, to flood the checkpoint with “good information,” in other words, signals associated with pain-free movement. In this way, there is no more room for the pain signals as they are crowded out.
The sensation of this simple pain-free motion dominates the information traffic on your sensory nerves with feel-good kinesthetic sensory information that identifies position, length, and force. Finding and repeating pain-free motions in your back will cause the remaining painful activities to hurt less. Read the previous sentence again – it really is that important.
By discovering and engraining positive movements for your back, you will find that the pain often dissipates and then disappears entirely. This is because when we remove pain triggers and stop “picking the scab” we give our tissues a chance to rest, heal and regenerate. Simultaneously our sensors for pain are actually being desensitized. Master this, and you have mastered your back pain.
For those of you that have a known type of injury, a name to attach to your condition, your personal recovery strategy should always begin with avoiding the aggravating posture for your unique spine is key to getting yourself back on track.
Various symptoms of back pain have a distinct and known cause (although this information is not widely known making this book uniquely valuable). Injuries can be avoided if we avoid the injury mechanism itself. Here’s a recap of some pain avoidance strategies, as well as an introduction of some that will be discussed later. The knowledge in this chapter will provide the foundation that will help you:
Locate and eliminate the cause of your pain- get an appropriate assessment that provides a specific diagnosis (Make an appointment or start with reading chapter 6).
Increase your consciousness around what movements and postures cause you pain.
Develop replacement postures and movement patters that enable you to function pain-free.
Stabilize your torso, core, and spine to remove painful spine joint micro-movements.
Develop a daily exercise plan that includes walking.
Mobilize your hips and use your hips to lift.
Learn to create power at the ball and socket joints (hips and shoulders).
Learn exercises that are based on patters of movement: push, pull, lift, carry, lunge, squat, etc.
Make healthy spine choices when sleeping, sitting, or engaging in more demanding activities.
You’re on your way to learning the secrets of a pain-free lifestyle! Let’s make it happen!
I recently posted a research journal that stated that after an injury patient’s gait might need to be retrained. Here is an example of a patient with a dysfunctional gait:
Take a look at this patient’s gait. Watch her left leg and then watch the right leg. The left knee tracks outward. Look at the patient’s knee. It points outward right instead of pointing forward. Look at the patient’s foot. This patient is towing off laterally and not getting into her big toe.
The second video is after treatment of adjustment to her foot, ankle and lower back, plus a week of home exercises along with some mental corrections. Patient was cued on the changes in her gait and how to improve the lower extremity function. We practiced in the office and the patient was sent home with some homework.
This is an example of how gait retraining can help improve a patient’s function. Strengthening the body is very important but strengthening dysfunctional movements will not progress the patient towards optimal.
Another study showing that obese patients who got COVID-19 had a worse outcome . COVID-19 has brought to light that the more unhealthy you are the, the worse the outcome will be for you.
Now is the time to get healthy. Start exercising! No matter what you do, it’s better than nothing. Make small changes to our diet and finally start to sleep more. These simple things can help change your life and put you on the road to health. It might not stop you from getting COVID-19 but you’ll be better able to fight off the infection.
American Heart Association analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association’s COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group. They found:
“Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years).” say the study authors. “Obese patients are also at higher risk for venous thromboembolism and dialysis.”
If you need any help with your quest for health, call the office to make an appointment and together we can make a plan to improve your health. Now is the time to start so what’s holding you back? Pain? I can help with that as well!
Lower crossed syndrome is something I see -or a version of it- in almost every lower back patient I treat.
If one muscle is weak another muscle has to do more and becomes over worked. In turn becoming tight and painful.
I’ve heard this about 1,000 times- “I keep stretching muscle ‘x’ but it’s always tight.” Maybe it’s not a stretching problem. It could be a strengthening problem. By strengthening the weak muscles you will help “turn off the overactive muscles”.
I have not had a patient with chronic pain that had strong abdominal muscles. It’s a very common problem.
When the abdominal muscles are inactive and not supporting the spine, while the spinal erectors are pulling the lumbar spine forward, it results in something called hyperlordosis.
This means that the spine in the lower back has an exaggerated curve, which can result in accelerated degeneration of the joints of the spine.
At the same time, the hip flexors are facilitated and are chronically tight while the gluteus muscles are inhibited and have reduced activation.
This leaves the back muscles to do most of the work to extend the spine instead of the gluteus muscles keeping the pelvis level. The muscle of the back are good a stabilization and less effective as a prime mover.
The overuse causes painful and tight muscles.
Treating a patient who has a lower cross syndrome, is three parts:
Chiropractic is the best choice for drug free health care. The United States opioid epidemic is well documented. (1) Seeing a chiropractor is a great way to treat pain without pain medicine. Chiropractic care with a good home exercise program is a great way to treat most conditions. Throw in some movement correction and ergonomics now we’re talking about great care.
“Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription.” Pain Medicine (2)
“Offering (chiropractic) services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.” Journal of Primary Care & Community Health (3)
“Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription” Archives of Physical Medicine and Rehabilitation (4)
Here at Sikorsky Chiropractic we use adjustments, exercises, ergonomics, movement corrections to help patients become pain free.
Chiropractic first, medicine second , surgery last resort. We are always putting the patient first.
Whedon JM, Toler AW, Kazal LA, Bezdjian S, Goehl JM, Greenstein J. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. Pain Medicine. 2020 Mar 6. Link
Prater C, Tepe M, Battaglia P. Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain. J Prim Care Community Health. 2020;11:2150132720953680. doi:10.1177/2150132720953680 Link
Louis CJ, Herrera CN, Garrity BM, McDonough CM, Cabral H, Saper RB, Kazis LE. The association of initial provider type on opioid fills for individuals with neck pain. Archives of Physical Medicine and Rehabilitation. 2020 May 11. Link
Not getting enough sleep can have negative effects on your health. They can be weakened immune system, increased risk for diabetes, heart disease and poor coordination. Add one more increased craving for sweets.
Insufficient sleep is linked to increased caloric intake and to obesity.
In a randomized crossover study, 24 people slept for either five or eight hours per night for three consecutive nights. The shorter sleep increased objective sweet-taste preference and intake of calories and carbs at the buffet meal.
While shorter sleep was associated with an overall increase in caloric intake, it affected different individuals very differently. Some ate a lot more (up to +679 kcal), but some actually ate less (down to −261 kcal).
One of the simplest thing you can do to improve your health is to sleep 7-8 hours a day.
The one sure thing about Covid-19 is the more unhealthy you are the worse the outcome will be if you get Covid-19.
According to the CDC: Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.
91 percent of Covid_19 deaths in Cook County had comorbidities. Comorbidity rate of Cook County victims with COVID-19 listed as primary cause of death, Mar. 16 – Jan. 1 (Wirepoints Source: Cook County Medical Examiner)
It found: “The SARS-Cov-2 infection has become pandemic, overlapping with obesity and its co-morbidities. Obesity and its co-morbidities create an unfavourable inflammatory environment that enhances the risk of severe COVID-19. Therefore, obesity must be recognised as an independent risk factor for COVID-19 severity to better define public health policy and protect susceptible individuals, including specific social distancing measures. These measures can also contribute to preventing collapse of the health care system. Further research should define proper therapeutics for COVID-19, and nutritional therapy is an essential measure for treating COVID-19 in patients with obesity.”
Losing weight and getting healthy-along with the standard practices of social distancing, mask wearing, washing your hands and keeping your hands from your face and mouth- will help you fight Covid-19!