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
Take a look at this x-ray. Can you see how uneven the pelvis is? This is caused by an anatomical short leg. The spine is showing signs of degeneration (arthritis) as well as the left hip.
Frontal x-ray taken standing. The left side is the low side. Posted with permission.
So can a short leg cause back pain? The answer is yes. I have seen this multiple times in my practice. There are two major causes of a short leg. One can be functional. A function can be from twisting of the pelvis or tight or weak muscles. An example of this would be standing in a hole with one leg. There is no difference in the bone length in the leg but the pelvis can be uneven. The second can be an anatomical. This occurs when the one of the leg bone is a different size then the corresponding one. Think of a table with one leg a shorter then the others. Both can be treated with chiropractic care and home exercise but the way they are treated is different.
This patient had an accident when he was young that effected his Tibia (shin bone). This causes one of his legs to become a different length and cause an uneven pelvis. Years of walking and daily actives with a severely uneven pelvis lead to arthritis, disc degeneration and chronic pain.
Posted with permission. The left tibia is the one with injury. Posted with permission.
Things that happen to our legs/feet can effect our spine. The body is great at compensating until it can’t. A broken bone that heals shorter than the opposite one will lead to changes in how the body moves causing increased biomechanical stress leading to break down. The break down can be of the muscle, bone, cartilage or disc.
I want to thank the patient for permission to post these picture.
I love when a study confirms what I’ve been telling patients. I recommend fish oils to most of my patients.
This study confirms the importance of fish oils. A meta-analysis of 40 clinical trials found that supplementation with fish oil is associated with a 35% reduced risk of fatal heart attacks, a 13% reduced risk of heart attacks, and a 9% reduced risk of fatal coronary heart disease.
Specifically, the study found that EPA+DHA supplementation is associated with a statistically significant reduced risk of:
The study found that cardiovascular benefits appear to increase with dosage. The data showed that adding an extra 1000 mg of EPA and DHA per day decreased the risk of cardiovascular disease and heart attack even more. For example, the risk of cardiovascular disease events decreased by an additional 5.8% and the risk for heart attack decreased by an additional 9%.
Continue to take your fish oils supplement or even increase the dosage. It might help save your life!
If you have questions on where to begin, please call the office. Not only can Dr. Steve get you on the right track with supplements but we have them for sale.
Neck pain and Headaches are a very common issue in our
society, and understanding the causes and prevention of them will go a long way
to leading a healthy and pain free life. In this educational summary, we
discuss some of the most common conditions we see in our office. Below we will
discuss the following neck-related pain conditions.
Upper Crossed Syndrome
Headaches
Neck Sprain/Strain
Disc Pain
Cervical Radiculopathy
TMJ Dysfunction
Potential causes of
Cervical Discogenic Pain Syndrome
Direct trauma – falls, motor vehicle accident, whiplash, sports injury
Overuse, fatigue, repetitive microtrauma – over hours, days, months of the same position
Postural – can be either an intrinsic postural problem (e.g. loss of cervical curvature) or an extrinsic postural problem (e.g. prolonged stressful position, protruded head posture).
Sudden unguarded movement.
Degenerative disc disease.
Photo by cody berg This workstation is not set up correctly
Symptoms of Cervical Discogenic Pain Syndrome
The symptoms will vary
depending on whether the condition is caused by a herniated disc or by a
degenerative disc. With a herniated disc, some people will not experience pain
in the neck but will have radiating pain, tingling, and numbness down the arm or
around the shoulder blade due to pressure put on the nerve root. Discogenic
pain due to an injury can result in immediate pain or pain shortly after the
injury. Headaches (usually cervicogenic)
can also result from cervical disc pain.
Treatment of Cervical
Discogenic Pain Syndrome
Treatment for cervical discogenic pain will depend on the clinical
presentation. Conservative treatment can successfully manage many cervical disc
herniations. Initial treatment will focus on controlling pain and inflammation.
Once pain and inflammation have
decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft
tissue therapy, activity as tolerated, and pain-free
range of motion exercises. Late rehabilitation will be administered as the condition improves and will include
stabilization exercises, patient education, and postural training. Education in
proper training, biomechanics, and a home exercise program will help strengthen
the spine and decreases the likelihood of future injury. If you fail to respond
to conservative treatment, or in cases of severe pain, diagnostic imaging
(x-ray, MRI) will be warranted, and an
orthopedic consult may be necessary.
Cervical Radiculopathy
Cervical Radiculopathy is a
dysfunction of the cervical nerve roots resulting in various neurologic
findings. The cervical spine consists of seven cervical vertebrae and eight
cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or
weakness and though the problem occurs at the nerve root of the cervical spine,
these symptoms will often radiate to parts of the body controlled by that
nerve. The seventh (C7) and sixth (C6) cervical nerve roots are most commonly
affected.
In younger patients,
cervical radiculopathy is usually the result of a disc herniation or an acute
injury causing foraminal impingement of the exiting nerve. In the older
population, cervical radiculopathy is usually due to foraminal narrowing from
osteophyte formation, decreased disc height, or degenerative changes. In
elderly patients with osteophyte formation, repetitive neck movements may
result in a more insidious injury. Cervical radiculopathy due to sports
injuries can result from several mechanisms. Typical these injuries occur from
forced extension, lateral bending, or a rotation mechanism, which closes the
foramen and results in the exiting nerve root being
injured.
Risk Factors for Cervical
Radiculopathy
Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain or arthritis of the cervical spine. The pain may range from deep aching to severe burning neck pain. Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved. Occasionally, a motor weakness may develop of the shoulder or arm. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.
Treatment of Cervical
Radiculopathy
Initial treatment will
focus on reducing pain and inflammation and prevention of further neurological
loss. The focus will also be on centralizing (reducing) any radicular symptoms
by decreasing nerve root compression and pressure within the herniated discs. This will consist of manual traction and pain-free active non-resisted ranges of motion
while avoiding positions that increase neck and
arm symptoms. A cervical pillow at night can be helpful in maintaining the neck
in a neutral position and limiting head positions that cause foraminal
narrowing. Electrotherapy modalities may be used to help reduce any associated
muscle pain and muscle spasms. Once pain and inflammation have decreased, therapy will progress to
restore full range of motion and mobility of the neck and shoulder. This will include muscle stretching,
strengthening and proprioceptive training, and corrective exercises as
tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and as long as it
does not cause an increase in symptoms. If you fail to respond to conservative
treatment, or in cases of severe neurological loss, a secondary consultation
with a neurologist or neurosurgeon will be
recommended.
TMJ Dysfunction
“I’ve got TMJ” It’s a pretty common statement which is a bit of a misnomer. Everyone has TMJ. Why? The TMJ is the tempo-mandibular joint(TMJ). We all have it. What people are probably trying to say is that they have TMJ disorder, aka pain and dysfunction of the jaw while opening or closing your mouth.
What happens is the mandible (your jaw) connects to the rest of your head at the temporal bone. It’s a hinge joint that pivots through a cartilage disc called a meniscus in between the two bones of this joint. Unfortunately, it’s a common place for the TMJ to become subluxated or in other words, a little bit dislodged. After that, you can get overuse and degeneration of that joint. One way to tell if you have this disorder is to open your mouth and measure, can you open your mouth the height of 3 fingers for your hand? If not, you might have TMJ disorder.
The
main physical causes of this condition are:
trauma
overuse
from a commonly chewing on one side of
your mouth
keeping
the mouth open for extended periods of time (like at the dentist)
improper
bite
grinding
From a physical standpoint, the best way to prevent TMJ disorder is to wear proper mouthpieces while playing sports, wearing mouth guards while sleeping, making sure to chew food evenly on both sides of your mouth, cutting tough meats and other foods into small pieces and minimizing gum chewing. Having better posture also improve the alignment of the TMJ.
This study found that DISC HERNIATIONS RESOLVE BY THEMSELVES THE MAJORITY OF THE TIME! That is awesome. The study found that the overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%).
There is hope! Chiropractic works to restore normal mechanics to the spine and corrective exercise can help this process along.
Pass this along to anyone who is suffering! And if you are suffering be sure to make an appointment with Dr. Steve!
Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis.
People that come into our chiropractic clinic for treatment after lumbar disc herniation or disc bulging frequently have a history of pain which is worse in the morning and then improves after they’ve been up moving around for a bit.
Often they have some questions about what exercises and stretches they can do in the morning to make them feel better. We learned more about morning back pain in a disc – injured patient after the research of Michael Adams in the 1980s.(1,2) Adams referred to the “diurnal behavior of the disc” which mostly refers to the tendency for the discs to absorb moisture from the tissues around them overnight.
The discs soak up the fluids from the tissues around them while a person is recumbent in bed overnight. So in the morning when they wake up the outer layers of the disc are under a bit more tension, which we refer to as hydrostatic pressure.
In turn, the disc becomes a bit more plump, adding pressure to nerves and surroundingstructors.
So what should you do? Once you get out of bed you should not bend over right away. Try to keep your back straight or try stretching backward .
Next, use your hips to bend over the sink to brush your teeth.
A straight back using my hips to bend over.Bending at the lumbar spine causing lots of pressure on the lumbar discs
The above picture is a great way to cause sharp shooting pain in the morning.
Try to sit up straight or use a back support in the small of your back like in the picture above.
Sitting with a more normal curve in the lumbar spine helps take the pressure off of the lumbar discs and helps decrease pain.
A wrong way to sit
Sitting like this cause more disc pressure causing disc irritation. It can cause the disc to bulge more.
Discs are fatter in the morning because the absorb fluid overnight. So think of a jelly doughnut if the doughnut has more jelly its more likely to shoot out if you put pressure on it.
So remember back straight, stomach tight will help prevent lower back pain and help you heal if you have pain.
A weak core can increase your chances for lower extremity injury during exercise!
The core is important for your lower back and neck health for sure. It’s also very important for extremity health. If you have been dealing with an arm or leg injury (extremity) that has not been getting better with treatment, it might be good to add in some core exercise to improve outcomes.
Take Home Message from the study: A college freshman with dynamic postural control limb imbalances, decreased hip extension strength, or decreased core muscle endurance during bridging exercises is more likely to develop a lower extremity overuse injury.
This is a pretty cool picture. Can you believe the detail? The red in the picture is the muscle and the white stuff is the connective tissue is called fascia. A painful area in a muscle can be caused by damage to one or both of theses structures!
