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!
The visual that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back. Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode. Feelings of pain and helplessness are some of the reasons why low back pain is of the most common causes for patients to seek emergency care!1
In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months2,3! That’s pretty… painful to think about, actually.
On top of this, chronic low back pain is considered the second most common form of disability worldwide,3 and one of the most common causes for adults to see a family physician.4
In the past, patients were told to “take it easy” during a flare-up of low back pain. They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax spasming muscles and ease pain to more tolerable levels.
However, times have changed. Treatment guidelines instead recommend specific exercise4, gentle stretches, and other ways of staying active during the recovery process. Total bed rest is to be avoided.
In my practice everyone who come in with lower back pain get homework (exercises) to do. No mater how much pain they are in.
Why the change?
Part of the reasoning is anatomical. Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles5.
Superficial muscles are used to perform motions like bending and twisting. These muscles are strengthened by exercise that places stress on the muscles. Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.
Deep muscles, on the other hand, help stabilize the spine and maintain posture. Physical activity such as yoga, walking, and more, helps keep them in shape. Picture the jogger going for a mile or two before breakfast: they’re working on deep muscle strength.
A common scenario is bending over to pick something off the floor. You may hear a “pop” in your low back, followed by pain and muscle tightness. You’re bent over, unable to fully stand upright, and your world suddenly hurts no matter what you do. You go to bed – and stay there, unable to move because movement equals pain. You call out of work because you can’t get out of bed. You remain largely sedentary for a week, under the guise of “waiting it out.”
When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength. This is a process known as atrophy.6
As the pain subsides and the person feels some improvement, activity is slowly resumed. In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back. Although they can function in this capacity, superficial muscles are NOT well-adapted for this function! These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.
This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries.7,8
There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine. Doctors of chiropractic regularly prescribe exercise to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness.8
Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury.4 “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.
McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care.
In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely.
When you are experiencing a disc bulge or herniation, the disc material will often protrude posteriorly. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. Although in some severe cases surgery is necessary, the body has the ability resorb the disc naturally. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.
McKenzie extension exercises work because they force the spine to go into an extended position (when referencing the lumbar spine this means an “arched” back position.) This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This was visualized in the anatomical section of the course. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.
Before performing these exercises there are a few things you should pay attention to:
While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.
If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving. Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely
How do we perform these exercises?
You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.
If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises.
A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.
Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember – it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.
Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.
Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530.
Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.
Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.
Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.
Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.
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.
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.
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.
New research has re-affirmed that weakness of one cervical muscle group is closely tied to chronic neck pain. This unit is also implicated as a provocative factor for cervical radiculopathy, cervicogenic headache, and cervicogenic vertigo.
A 2020 JMPT study re-affirmed that weakness of the deep neck flexors is common in cervical radiculopathy patients:
“Current results confirmed the presence of cervical multifidus and longus colli muscle atrophy in subjects with chronic radicular neck pain.” (1)
The deep neck flexors include four muscles that lie behind the trachea on the front of the cervical spine. The group includes the longus colli, longus capitis, rectus capitis, and longus cervicis. Due to their proximity to the spine and their short length, the muscles are primary stabilizers of the cervical spine.
If you’re experiencing neck pain contact the office! We help ease neck pain every day.
Amiri-Arimi S, Bandpei MA, Rezasoltani A, Javanshir K, Biglarian A. Asymmetry of Cervical Multifidus and Longus Colli Muscles Size in Participants With and Without Cervical Radicular Pain. Journal of Manipulative and Physiological Therapeutics. 2020 Mar 1;43(3):206-11.
New research shows that using the legs, particularly in weight-bearing exercise, sends signals to the brain that are vital for the production of healthy neural cells. The groundbreaking study fundamentally alters brain and nervous system medicine — giving doctors new clues as to why patients with motor neuron disease, multiple sclerosis, spinal muscular atrophy and other neurological diseases often rapidly decline when their movement becomes limited.
Bottom line here folks: you have to move, you have to load, especially if you have a neurologic disorder and especially if you are declining in age. At the very least, throw some lunges or body weight squats into your day. Walk the stairs, don’t ride the elevator. Move. Lift. Strain.
Running has become one of the most common forms of physical activity in today’s society. It can be a community building activity, a personal challenge and most importantly a great work out. It is a sport that everyone can participate in; all you need is a good pair of shoes and a little motivation. That being said running can be extremely hard on your body, especially when you are just starting. We are finding that injuries among runners are very common. From shin splints to rolled ankles, no one is immune from getting hurt; however, here are some tips to keep you healthy and on pace.
Do not do too much, too fast
When runners are just starting and begin to make progress, they tend to push their limits. Although this is a great way to challenge yourself, it is important that you understand your body has a threshold that when exceeded results in injury. Your mileage should be tracked on both a daily and weekly basis. If you have never done much long-distance running, then your weekly mileage should begin quite low. It is important that as you improve your mileage increases gradually. A consensus among the running community is the rule of 10%. Do not increase your mileage by any more than 10% on a week to week basis. For many runners and new runners specifically, 10% may even be too much of a jump. This is why when preparing for a distance race, whether it is a 10k, half marathon or a marathon it is recommended you start as early as possible. Could you train and complete a half marathon in 6 weeks? Maybe, but the toll it could take on your body and the injury risk you are exposing yourself to are likely not worth it. A recent study showed that runners who only increased their mileage by 3% a week had a much higher rate of success in their upcoming races than runners who ramped up their mileage quicker.
So how do you know where to start? First, start with walking. If you can walk an hour a day with out any injury you may start running. As a new runner, start with short runs and accumulate miles over the week. It is important to understand how far you have been running, so I recommend using an app on your phone such as “Map My Run” to help track each run. Personally I have a Garmin GPS watch , that links to Garmin connect. Garmin connect is an app. Most GPS watches can be linked to an app.
Do not run through significant pain
As runners, we all understand some discomfort is a part of the sport. Your legs and feet will likely be sore after a long run; however, if you begin to notice significant pain or discomfort while running consider taking a break. Breaks are one of the hardest things to convince a runner of doing, but it could save you from more severe injury. Aside from the odd rolled ankle, very few running injuries are acute and traumatic. Far more commonly runners ignore the pain and “tough it out” when they begin to feel discomfort.
This can result in a cumulative injury cycle. What is that you might ask? It means if you continue to stress an injury by running, you will continue to make it worse and it can become a much more significant issue. Sometimes all it takes is an extra day off when symptoms are minor to allow your body to recover. This is important because if you have an injury, it is very common for your body to adapt by altering your gait (running pattern).
This may lead you to be less efficient, develop bad habits or in a worst-case scenario cause an injury elsewhere in your body. Remember, everything is connected, so if you are running with a limp the biomechanical stresses will be placed on a different part of your body. Give your body a chance to recover and if you think that an injury is nagging have a medical professional look at it. It is much more beneficial to have an injury taken care with a couple of sessions of treatment rather than letting it persist and having to deal with it when it is much more serious, and your recovery time is extended.
Call the office if you’re having pain. Do not tough it out! It could only get worse. We work with a lot of athletes and help them return to activity. Athletes looking to prevent injuries or perform better see us.
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
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
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.
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.
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:
& exercise habits
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 best way to stop muscle wasting is to lift weight and do some form of cardio vascular conditioning.
Which weight lifting exercise are best? They are called complex movements.
Here a list:
Dead lift ( hip hinge)
Pushing movements( push ups and bench press)
Pulling movements( Lat Pull down and Pull ups)
Now you don’t have to be muscle bound to do these movements. However, doing these movements with some weight would help keep the muscle you have and possibly add some muscle.
Now you might be thinking you can’t squat because you may have bad knees or a bad back. Squatting is basically getting out of a chair. So start with that, getting out of chair 10 time is a row. Doing that a few times a day is a great way to start! You will not believe how sore you can get from this routine. Once you have done this for a few weeks move on to some thing harder. Goblet squats are the safest. Start with a light weight and just keep adding weight. It’s that easy.