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:
Another study that shows Lumbar disc herniations can reabsorb. This is great news. Disc herniation can get better with chiropractic care, better body mechanics and hard work ( home exercises). So everyone that was told they need surgical intervention it might not be true!
Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown.
CONCLUSIONS:
The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH.Key words: Lumbar, disc herniation, spontaneous resorption, conservative treatment, incidence, country, meta-analysis, systematic review, observational studies, study designs.
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 the book if you have suffered or are suffering from low back pain. 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.
Try this: close your eyes and find the tip of your nose with your finger like in a roadside sobriety test. You are using kinesthetic sensory organs that run throughout your arm to navigate. These sensors alert the brain as to the position of your forefinger in relation to your nose. 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 ( you will be able to obtain your own by 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
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!”
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
This will be a multi part series, going over the list above.
Upper Crossed Syndrome
Upper Crossed Syndrome describes a type of common muscle imbalance. This occurs when the neck flexors and the middle back become weak while the pectoral muscles and the muscles at the base of the skull become tight. This produces a familiar pain pattern at the base of the neck and the shoulders, as well as joint dysfunction at the base of the skull and shoulders.
The main physical causes of this
condition are:
Desk
job
Too
much sitting
Driving
long hours
Poor
posture
However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often have poor posture while sitting at a desk for most of the day. A comorbid factor is a sedentary lifestyle with little physical activity. This poor sitting posture leads to a re-enforcement of the Upper Crossed Syndrome, and it is crucial that you arrange your workstation to facilitate a proper posture as best as possible.
The
best way to combat this problem is, of course,
to prevent it before it starts. If possible, minimize sitting for long periods
of time and take frequent work breaks to take short walks around the office to reset your posture.
If the problem has already begun, Dr. Steve can teach you proper form and posture to prevent this problem in the future so that you are more mindful of the positions that can promote this problem. I am also trained in soft tissue techniques that will be able to relax your tight muscles, restore motion and reduce pain levels. There are also methods of rehabilitative exercise that can be taught to you to reverse any damage already done and prevent a progression of this condition, as well as instill healthy habits for you to employ for the rest of your life.
Headaches
Headaches
come in many varieties, and nearly
everyone experiences this type of pain at some point in their lives. The common symptom of all headaches is of course
characterized by pain. Different types of headaches cause pain in
different regions of the head and have unique pain sensations. Some portion of
people experiencing headaches can be
characterized as migraines. Migraines often feature symptoms such as
nausea, vomiting or sensitivity to lights.
The physical causes of this
condition are extremely numerous, but
some of them are:
Allergies
Stress
Poor
posture
Diet
& exercise habits
Hormonal
imbalance
Smoking
Since there are so many different types of headaches, as well as causes and symptoms, it is important to get a proper diagnosis so that you can better treat the cause. An assessment of your lifestyle habits is an effective way to diagnose common contributing factors that may be causing your headaches. For example, addressing your sleeping habits, making sure you get the proper amount of sleep and making sure you are getting restful sleep. A proper, healthy, balanced diet that is free of any substances that you may have a sensitivity to or may be a trigger for headaches is important for managing this condition as well. Posture and body habitus can be huge contributing factors and may be some of the simplest to diagnose and manage. Treatment such as soft tissue modalities as well as chiropractic adjustments coupled with posture analysis and correction can be a simple and effective way of managing headaches of this type.
Next week we will have more on this subject! In the meantime please call the office if you have neck pain or headaches that we can help you with!
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
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.
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!
Here’s another study showing that disc herniations can spontaneously resorb. The body has a amazing healing capability! We just need to give it a chance and the correct environment.
In 40 patients with lumbar disc herniation: “Based on MRI disc volume; 10% did not show any regression, 15% had a partial regression, and 75% had a complete resolution. Patients with complete resolution showed a significant improvement in the pain score and the ODI score over time.”
Kesikburun B et al. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci. 2019 Jul-Aug;35(4):974-980. Link
Cervicogenic Headache are headaches coming from the neck. There are many cause of headaches. Chiropractic has been shown to help headaches caused by neck dysfunction.
A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:
“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits.”
Call the office if you have been suffering from headaches! If you have tried medicine but you are still having headaches then give chiropractic a try.
Tech neck happens when people spend too much time with their head and neck extended too far forward over their body while looking at a computer screen. It can also happen when people repeatedly tuck their head down over their chin and hunch their shoulders while sending or receiving text messages on a cell phone.
Symptoms: •Neck pain •Shoulder pain •Shoulder blade pain •Pain in arms and hands •Numbness in thumbs and fingers •Headaches and/or Migraines •Fatigue •Eye strain and blurred vision
Minimize Tech Neck by:
Bring screens to eye level
Use a tablet or smartphone holder
Take frequent breaks from screens
Strengthen mid back and cervical extender muscles
Call Dr. Steve for help with your posture and tech neck!
