"What Jobs Cause a Bad Back and What Can I Do About It?"

"What Jobs Cause a Bad Back and What Can I Do About It?"
Back problems are commonplace in society. It is important to ask if there might be certain risk factors for back injury that should be avoided if possible. While we cannot pick our genetic make-up or even our current occupation (for most of us), how we interact with our daily tasks can be the difference between disabling pain and minor aches.

Some of the most strenuous jobs are those tied to the construction industry. Concrete-reinforcement workers and carpenters have more back pain than what is typically seen in office workers. But office workers can be a greater risk for carpal tunnel symptoms. Each of these jobs has unique characteristics that make certain locations of the spine more affected than others.

Lifting heavy weights (e.g. concrete, lumber), especially in awkward positions, makes the discs in the low back vulnerable to the load, which can exceed the strength of the ligaments. This is called a sprain, and in severe cases the disc can bulge or herniate. If the worker can use good ergonomics (e.g. symmetrical lifting), then the disc can more safely resist the load. It is also known that the spine is more stiff in the morning, and develops higher pressures in the disc when a worker lifts at this time of day. Taking this into account, one can do more light lifting in the early morning. In almost every case one should never lift anything, even a light object, by doing a twisting motion. This action is where the spine can easily be damaged. Getting a buddy to help with a lift is a solution that many do not try.

Sitting for prolonged periods can also be damaging to the spine. First, there is the inactivity, which causes muscles to become weak. The spine is designed for movement, especially walking. An apple a day is good, but a walk a day is better. Sitting also causes increased pressure in the disks of the low back. If you add vibration (e.g. bus drivers), the sitting seems to be much worse. An anti-vibration seat, frequent walk breaks, along with a chair that provides proper support, are the main counter measures.

Each job has its own unique ergonomic characteristics and should be assessed accordingly. Proper spinal posture while working is a key to overall good health and is the best prevention for back injury.

Is Your Neck Causing Your Low Back Pain?

Is Your Neck Causing Your Low Back Pain?
For most of us when we hurt the low back from lifting, the pain starts at the lower spine. It’s usually not a difficult connection to make—that if it’s the low back that is strained, it is the low back that is injured. But, in some cases the back pain seems to creep up, or come out of nowhere. Sometimes you wake up with the pain and there was no trauma at all. In these cases it is even more important to examine the entire spine for the cause of the problem.

The nervous system is enclosed within the bony spinal column and skull. Nerve signals travel from the brain to all distant areas of the body: to organs, muscles, etc. All of these nerves pass through the neck region, even nerves to the legs. This is why an injury that affects the neck can have ramifications in the areas below. The nerve system is a communication link from brain to tissue, and when the nerve is pinched or irritated, there’s a break or miscommunication in the signal.

Most of us are aware that a person can become paralyzed from a bad neck injury such as a fracture. But what is less well known is that minor sprains of the neck can have an effect on muscle tension and pain in the low back. Some chiropractic techniques specialize in only adjusting the upper portion of the neck because this area can have a profound effect on the entire body.

How neck problems can affect low back is not well understood and is being researched. Some theories are that neck problems tend to cause changes in balance. People tend to sway a bit more when neck problems such as whiplash are present. Perhaps this lack of coordination of the muscles leads to poor recruitment of muscles when we lift.

Another theory is that if nerves are initially irritated at the top of the neck, they become more susceptible to pinch or irritation at other more distant regions of the spine. The spinal cord is also attached to the upper neck vertebrae. If twisting of the upper neck bones occurs, this can pull on the attachments which link to the cord. Disk protrusions in the neck can also compress the front of the cord, sometimes causing symptoms into the arms or legs.

A thorough examination by a doctor of chiropractic will determine if your low back condition is coming from a neck injury.

Is Your Back Healing OK?

Is Your Back Healing OK?
It’s a good question. We want to do the things that promote and speed healing and not do the kinds of things that cause more harm or are destructive. A lot of us know that a little rest when we injure the back is ok, but staying in bed for a week might not be a good idea. Studies have shown that bed rest for more than 2 days causes even more pain. Since our goal is to move, then lying down doesn’t seem like a worthwhile step towards that goal.

Some of us know that when the back flares up, ice is better than heat. Some of us still don’t, and instead throw gasoline on the inflammation fire by having a soak in the hot tub.

These things are obvious on the list of do’s and don’ts for the person with low back pain.

It seems like taking a pill for few days to help with pain is reasonable enough. Right? Maybe wrong.

For example, certain NSAIDs (e.g. ibuprofen) can make the scar formation in a muscle strain less effective. Instead of the scar being formed properly, it is in a more disorganized or scrambled fashion. If you have a poorer scar, the tissue will not be as strong and could lead to re-injury or a delay in your recovery. We don’t think about it but just not taking pain pills early on would help for a lifetime. Ice can be an effective pain killer and doesn’t come with medication-side effects.

Muscle relaxants are also prescribed for people with back pain. They are consumed by 49% of patients. The theory is that the muscle spasm should be relieved so that there can be less muscle pain. A study of patients who took muscle relaxants showed that these sufferers recovered more slowly. Unfortunately, the muscle spasm is there for good reason: to protect a delicate nerve.

Another thing that you have to consider besides poor scar formation and slowed healing, is the actual purpose of these medications. You have to also ask yourself why your body wants you to feel this pain. The body wants you to protect the area from movement. If you block the pain with medications, you may move too much, or too soon in the healing process, delaying your recovery.

A study that compared chiropractic adjustments to muscle relaxants in patients with low back pain had interesting results. There was also a sham adjustment group and a placebo medicine group. The authors concluded that chiropractic care had superior results.

The chiropractor can help guide you to when you can return to certain work or sports. By gradually integrating exercises into your daily routine as the function of the joints is improved, your injury can heal more naturally.

What Can I Do To Prevent Low Back Pain?

What Can I Do To Prevent Low Back Pain?
One important concept in spine care is making the patient an active participant in their rehabilitation. It’s important to change our sedentary lifestyles so that we not only get well, but also do things that prevent problems from occurring in the first place. But first, it is important to understand how back injuries occur. When we bend and twist and pick up things, tremendous forces are placed on the disks and ligaments of the spine. It’s important for muscles to be coordinated and flexible so you have maximum strength to resist.

Hopefully you’ve begun an exercise program. One of the more neglected areas of daily spinal hygiene is stretching. By stretching the muscles that move the bones and joints, we make them more flexible. This can make you more resilient at resisting heavy or awkward loads.

The important thing is to do stretches correctly. In general, you want to be warm when you stretch. If you’re not too warm, then proceed slowly, gradually bringing more circulation to the area. After a long walk is a good time to stretch. You can also do stretches throughout the day, even in your office chair. Simple hand and shoulder stretches can be done at the computer, and can help to release tension in the shoulders and wrists.

It’s helpful to hold the stretch for at least 40 seconds so that the muscles have a chance to respond and elongate, and do not bounce, or move in a quick or rapid way.

If you have a back or other joint injury, it’s important that certain stretches are avoided, because they can further increase the stretch on ligaments. For example, you may not be able to touch your toes right now, but there are better ways to gain this flexibility than through toe-touching stretches. This is because bending forward can also aggravate a lower back condition. Instead you can bring the leg up to stretch the back of the thigh by placing the foot on a chair or table (acting as ballet bar). By keeping the low back in good upright posture, the back of the thigh is stretched while also lowering the stress on the spinal disks.

The Problem of a Low Back Problem

The Problem of a Low Back Problem
If you watch much television or have paid a visit recently to a family medical doctor for low back pain, the information you’re getting may be a flawed. For example, you’ve probably been told that back problems are not very serious and that the problem is quickly cured with simple treatments, such as going back to work or taking an aspirin. One commercial recently aired, shows a patient bent-over in a stuck position, who is apparently cured by taking two aspirin. These advertisements convey the message that back problems are trivial and that cures come in a bottle.

The reality is far different. Few studies show that taking pills does any good at all. More importantly, they tend to mask mechanical problems of the back that need mechanical types of treatments. Most back pains are problems of the spinal joints, either moving too little (fixation dysfunction), or too much (instability). These small problems grow bigger when you consider the spine is the lifeline of good posture. You really can’t do very much with a bad back. You may not be able to work, play, or even sit for longer than fifteen minutes. This can have far reaching consequences for everyday life and its enjoyment.

Treating these minor aches and pains as signals of something wrong that needs to be properly diagnosed and corrected is the best way to manage this type of injury. When these problems are ignored or improperly treated, it’s only a matter of time before the minor sprain turns into a disk protrusion, and eventual degeneration or arthritis. With arthritis there will be substantial limits on the function of the low back. With lack of function comes reduced quality of life.

I specialize in the mechanical treatment of these painful spinal conditions. My treatments involve spinal adjustments, which are designed to correct the misalignments of your low back vertebrae, and improve the range of motion of the individual spinal joints. When joints are functioning normally, the nervous system will be less irritated. Your back muscles will become more relaxed and less painful if the joint is not irritated through improper position or excessive motion.

A comprehensive examination is the only way to determine if chiropractic treatment will be right for your particular spinal problem. I can also provide advice on how to minimize recurrences and prevent future flare-ups. By addressing problems when they’re small, future disability may be avoided.

Low Back Pain: Getting Back Your Balance

Low Back Pain: Getting Back Your Balance
Our sense of balance comes from a few different areas of the body. The inner ear gives us input on the position of our head and whether we are moving. This is combined with input from the eyes, which gives similar information. Most people think this is where it ends, but the spine is also integral to maintaining proper balance.

Tiny nerve endings in the spinal column send information about position and movement up the spinal cord and into our brains where it is integrated with information from the ears and eyes. A person can become imbalanced through disease in any of these areas: eyes, ears, and spine. Inner ear infections, but also head and neck trauma, can dislodge tiny particles in the inner ear that give us balance feedback. The spine can also be primarily injured through traumas to ligaments and muscles. In addition to neck trauma, patients with low back trauma can also have their balance affected.

Patients with chronic low back pain tend to have more sway to their posture, which means there is less margin for error if one trips or misses a step. There is also reduced response time, which is needed for unexpected events. Part of the rehabilitation of chronic low back pain involves getting back the sense of balance if it has been affected.

You may find when your postural muscles are strengthened, back pain is reduced. Even more important than this, strengthened postural muscles can help prevent falls, which occur more frequently when your sense of balance is affected by disease.

Can you stand on one leg for five seconds or twenty? Have you fallen or had a few near misses in the past month? Have you broken a bone due to a fall?

We can diagnose why you may be suffering from balance problems and low back pain. A home exercise and balance program can be prescribed to make sure your spinal muscles and joints give proper input into the brain.  You’ll probably start by standing on one leg, if you can do that, and then progress slowly through more challenging postures, such as bending your knee, or moving one leg around. It’s important that a doctor evaluate you before commencing with balance treatments. You do not want to fall during your exercises.

Low Back Pain: Fix the Problem First and You Won't Need to Worry about the Pain

Low Back Pain: Fix the Problem First and You Won't Need to Worry about the Pain
It’s gotten a bit confusing how we sometimes look at our health. When pain strikes the low back we usually think we just got a new problem or injury. But why then was coughing, shaving, or doing the laundry, so different this time? These are things we do everyday. Rarely is a new episode of low back pain brought on by a well-defined injury or trauma. Trauma in most cases is usually quite trivial. We confuse pain as a signal for something that is physically changing each time.

So what is the problem? The problem is joint sprain or subluxation. This is a ligament problem and occurs with small micro traumas over many years, or sometimes with acute events such as car accidents or falls. Over time the ligaments stretch, causing the joints and vertebrae to displace, irritating the delicate nerve fibers. But over a few days or weeks, the pain that accompanies this injury gradually lessens, and in many cases goes away all on its own. But has the problem also gone away? Likely not, because when ligaments are traumatized, the repair mechanism involves scar tissue, which is less elastic than the original, and makes the joint vulnerable to re-injury and sometimes impairs the free and symmetrical motion of the spine. The doctor of chiropractic examines for this type of joint sprain using palpation for tenderness and edema, and x-rays to see the directions the vertebrae have moved towards. These specific analyses can tell us the vulnerable directions and how the vertebrae need to be repositioned to promote good alignment and good posture.

The adjustment is designed to reduce this misalignment, and induce more symmetric motion. When movements are asymmetrical in the spine, they can lead to premature degeneration of the spine and arthritis. This may be why a simple task such as lifting a laundry basket can flare up the back so easily. You may be lifting with good form and posture but with an asymmetrical spine, the loading is very off balance. Sometimes the disks are so damaged that a simple sneeze is enough to cause excruciating pain. So when these trivial events seem to trip you up, it means there is an underlying problem that is not getting corrected.

Low Back Problems and Their Cause

Low Back Problems and Their Cause
Low back pain, for many of us, is somewhat of a middle age problem. Lots of sufferers begin to seek chiropractic care in their 30’s and 40’s and wonder how it all happened. Perhaps it was a sneeze, a long drive, or gardening in the yard that set the pain off. But you were always able to do these things before without so much as a chirp from your low back. And now things are different.

So how come your back seems so weak, when it was so strong before? What changed? Not much in fact. The reality is that back problems begin during our youth. With advances in MRI technology we can study changes in the disks of the back to see when these injuries first occur. Spinal degeneration begins to occur at age 10, provided some trauma has occurred, such as from competitive sports or simply goofing off as a child. Rarely is significant pain involved and the child seems to shake off the injury with little future consequence. But having back pain is not the same as a having a back problem, such as a sprain of the disk. When the pain subsides, it does not always mean that symmetrical motion of the joint is restored and the vertebrae are now back in their normal position…but the pain may be much less.

Our bodies have a tremendous capacity to heal on their own without any type of doctor helping out. Mother Nature and innate intelligence is the best doctor, but sometimes recovery and return to full and optimum health is incomplete.

Over time the effects of gravity and daily stresses, cause the joint to become more injured until something as simple as making the bed causes excruciating pain. But was it really the bed making? Probably not because this is something you’ve done every day of your life. A thorough examination by a doctor of chiropractic prior to the onset of pain could have perhaps discovered one of these “silent” injuries. But most people wait until the pain happens before seeking help.

It’s important to be checked after a trauma, even in young children. Properly diagnosing the extent of injury is the first step to getting you the care you may need. The pain often goes away quickly and we often think the problem has also completely healed.

Getting regular check ups to make sure the motions of your spine are fluid and symmetrical is one potential way to avoid bigger problems down the road. Your doctor of chiropractic can also advise you on preventive strategies to minimize the risk of injury, such as proper lifting techniques.

Low Back Pain and Work Injuries

About 1/3 of patients with low back pain will consult a doctor of chiropractic. People who injure their low back on the job also often consult a chiropractor. One study (J Occup Environ med 2007;49:1124;Wasiak R, Kim J, Pransky GS) looked at these on-the-job injuries and how chiropractic care was used. In this report from Massachusetts, about 89% of workers initiated chiropractic care within 30 days of the injury and about half (48%) were done with their care in the same time frame.

At work and during lifting the lower spine and disks are especially vulnerable to injury. Heavy loads or simply awkward or stooped positions can be risks and should be avoided. Of interest, more people tend to injure their back in the first two hours of a work shift. This may be because the disks swell up with water during sleep and are more pressurized first thing in the morning. Or perhaps we’re not as attentive to lifting with good form, first thing in the morning.

If you’ve suffered a back injury it’s important to get checked soon so that you have the best chance for getting back on the job quickly. Bed rest and staying inactive are usually not healthy options for treating the low back. Inactivity can make back sprains worse by causing the muscles to weaken. Walking keeps pressure off of the disks and keeps the muscles engaged. If walking aggravates your pain, then it has to be avoided in the short term. Of course lifting following a back injury has to be limited. It’s important to lift with your legs and to avoid twisting motions.

Chiropractic adjustments are designed to improve the mobility of the spinal joints, improve posture and decrease tension on the delicate ligaments and nerves. In many studies chiropractic care has exceeded the results seen with conventional medical treatments such as medications or surgery.

When a back injury occurs, commonly the vertebrae move out of their normal position from the stretch of the supporting ligaments. Simply leaving the ligaments in this stretched-out position may not be healthful in the long run. Since the ligaments are injured, the vertebral joints tend to move abnormally. This is called a mechanical back problem and is one of the most common diseases of the lumbar spine.

Low Back Pain and Subluxation

Low Back Pain and Subluxation
Subluxation means a vertebral joint of the spine is out of its normal position. It’s the same as a sprain because the ligaments are stretched when this occurs. But how does a joint get out of its normal position? Usually, the culprit is some sort of trauma but not necessarily at the level of a high fall or a major car accident (although these trauma do cause problems).

Many times, the spine is injured because it is more vulnerable in awkward positions, such as when we bend forward and add a little twist to a lift. Perhaps it’s putting a baby seat into the back seat, or pulling weeds in the garden.

For many patients, it’s life’s trips and tumbles as a child that set the stage for a problem years later. We can all remember how we thought our spines were once invincible. The reality is something much less. Those jumps from the rooftop did have a consequence.

That small sprain of the ligaments did just enough to make the joints function abnormally. Over time the muscles adapt and our movements become less even. Then some twenty years later, a simple sneeze or less throws our back out. Some patients get back pain when they are under work stress or have to sit for long periods of time.

The important thing is to get subluxations reduced or corrected. The adjustments we perform at the clinic are meant to align the spine and make the movements of spine symmetrical from side to side. This tends to reduce the tensions on ligaments and muscles, and most importantly, makes you feel better.

When your spine moves normally, you may have less pain when you exercise or move the spine in a stressful way. We can’t make the ligaments perfect, there will always be scar tissue, but we can optimize your life and improve its quality. For many, just working without constant pain can be a real lifesaver. Many patients find their moods improve and they cannot wait to return to the sports or hobbies they once did. This is true wellness, healing not just the body but also the mind. Being in chronic pain is not much fun. While drugs can help many people and get them out of excruciating pain, they do have their limitations. Chiropractic can be a drug-free and natural alternative for health.

Low Back "Do"s and "Don't"s

We all know it’s important to maintain good back health by doing things that help strengthen it and avoid the things that cause harm… this is just common sense. But just what are the things we need to avoid and what are some simple things we can do to prevent back problems from occurring in the first place?

Most people are aware of the “lift with the legs” motto, which means bending your knees when lifting something. But there are also some other gems you need to know to avoid a back injury. First, the back disks are highly pressurized (full of water) first thing in the morning. This makes your back more stiff. It also makes stresses on the disk more substantial with lifts. So if possible, avoid lifting heavy things or in stooped awkward positions, first thing in the morning. If you have a choice of doing laundry first thing in the morning or at night, do it at night.

Another thing to think about when lifting something awkward or heavy is to get some help. There’s no point in trying to be superman or superwoman and test the limits of your back strength. A second person helping could save you a trip to the chiropractor.

Another “don’t” for the low back is to avoid sitting as much as possible. While some jobs make this difficult, there’s no reason to follow eight hours of sitting at the job with four hours of evening sitting at home. The back craves and thrives on motion, especially walking. Why not go for a thirty-minute walk after dinner, instead of being a couch or chair potato? The spine is architecturally designed for walking. This is where it is at its optimum. Sitting in a chair is a very unnatural position for the lumbar spine. The walking, while helpful for the back, can also pay dividends for your heart health and longevity.

Another important “do” for the low back is stretching. Simple stretching for 30 seconds each, the calves (lower legs), hamstrings (back of the thighs) and quadriceps (front of the legs), can help to keep the back flexible. Recall that we are supposed to lift with the legs. If the legs muscles are tight and/or weak, then the low back is going to take up much more of the weight and stress, increasing your risk for injury.

If You Have Back Pain… Do You Really Need An X-ray?

If You Have Back Pain… Do You Really Need An X-ray?
Most chiropractic patients have x-rays taken of their lumbar spine. Since x-rays do carry a very small risk of tissue damage, this risk needs to be outweighed by benefits. So, how are x-rays used in our clinic?

First, x-rays can tell us about medical conditions that may require referral to another health care provider such as a spine tumor or an infection. Fortunately, these diseases are very rare, but they do need to be considered in every patient, especially those who may have certain “red flags” such as back pain at night or rest, or if there is also a fever. In addition, certain severe traumas (like a fall) can produce fractures. In an older adult with osteoporosis, or someone taking steroid medications over years, even a minor trauma event can be enough to cause a break, because the bone is in a weakened condition.

After these very rare conditions are ruled out, your x-rays can provide important information about your anatomy and physical posture. For example, curvatures of the lumbar spine, such as scoliosis, are virtually undetectable without an x-ray. If we know how your spine is deviated, this information can help direct the adjustment more specifically. Sometimes leg lengths are uneven and a person may require an orthotic (arch support) or heel lift to level the foundation for your spine. About one in ten patients will have an unequal leg length of a centimeter or more.

In terms of the bone anatomy, x-rays can show the planes and angles of the disks between bones and whether any degeneration is present. If the degeneration is advanced, then a natural bone fusion may be present. It should be obvious that if the spinal anatomy does not allow movement or if the joints are literally fused movement is impossible, then adjustments are not appropriate.

X-rays can also show us how one area of the spine mechanically compensates for a deviated area below. Sometimes, pain may be present at compensatory areas but without knowledge of the cause of this deviation, care may be less optimum. Just as the lumbar spine may compensate for a pelvic problem, so to can a neck condition be caused by abnormal postural lower down the spine. The x-rays can show us how case management needs to be altered to reflect your individual needs.

In any case, x-rays are important to reach an accurate diagnosis, which is the first step on the road to recovery and regaining your vitality and quality of life.

Low Back Pain: Is It Serious?

Low Back Pain: Is It Serious?
Back problems can cause a good deal of worry and for good reason. Any problem that doesn’t go away on its own in a reasonable period of time should be a cause for concern. Rarely, severe back pain can be caused by tumors and other destructive processes, so it’s important to have these serious conditions ruled out with a thorough examination and x-rays or other imaging.

The other serious aspect of back pain, much more common than a spinal cord tumor, is how it can affect your quality of life, often with devastating consequences. Research has shown how disabling severe back problems can be. In terms of quality of life, the decrease can be even more than that seen with heart and lung problems. This may not seem correct at first glance, but if you think about a back problem making you unable sit or function at work, or basically being able to enjoy life, then it becomes more understandable.

The trouble is, many of us think lying on the couch will do the trick, or taking aspirin every day is a good long-term solution.

Sprain subluxations that displace the joints of your spine are sometimes referred to as mechanical disorders. These can be detected by analyzing how your spine moves in a precise manner. Sometimes x-rays can show displacements of the lumbar vertebrae or pelvic bones.  X-rays are taken from two angles to see the alignment of the spinal joints. X-rays can also show bone destructive or degenerative processes that help to diagnose your problem, and show if adjustments are indicated.

We direct our care at improving the posture and mobility of the spine as a way to speed recovery. We find that just addressing the pain with medications or adhering to strict bed rest can be counter productive. The adjustments are applied in a careful and specific manner. As the loads on the spine are more equalized and as joints begin to exhibit more flexibility, the body is placed in a more optimal environment for healing. Since self-care is also integral to our approach, we will encourage proper stretching and exercises to help maintain and extend what we can do in the clinic.

Alternative to Back Surgery?

Alternative to Back Surgery?
A recent large-scale study from Great Britain has results that’ll make you wonder whether back surgery is always necessary (Bhattacharyya M. Does the risks and benefits of spinal manipulation in patients with low back pain as a nonsurgical approach translate into better outcomes in routine clinical care: a prospective observational cohort study. J Bone Joint Surg 2008;90B:Suppl.492.). One hundred two patients were followed while they waited to see a spinal surgeon. The patients had disk herniations confirmed by MRI and had sciatic/leg pain. They had also previously tried 4 weeks of medications (non steroidal anti-inflammatory drugs), which had provided no benefit.

While they waited to see the spinal surgeon, they were referred for manipulations provided by experienced chiropractors. The adjustments were given five days per week.

A few patients had some transient increase in pain and there were three treatment failures (out of 102). Overall the results were very encouraging with patients moved off of the surgery wait-list.

But how is this possible? The disks are the hard cartilage separating each vertebra in your lower back. When this ligament sprains it can bulge onto a nearby nerve, causing back pain or pain down your leg. Precise adjustments use the bones as levers to affect the alignment of these vertebrae and the movement of the joints in the lumbar spine. If alignment is improved, then there is better posture and distribution of loads. When the mobility is more symmetrical, this also may prevent unequal loading of the soft tissues. Helping these mechanical aspects to heal can be enough to lessen your pain and help you to regain your quality of life. In some cases, it seems it may even keep you from a potentially unnecessary back operation.

Based on the results of the study, anyone without need of emergency surgery should try chiropractic care before having an elective operation for a disk or sciatica/leg pain disorder. Emergency problems would be symptoms like bowel and bladder dysfunction and numbness over the tailbone or hips. Most patients do not fit into the emergency-surgery camp.

Low Back Pain (…or is it?)

Have you ever had leg pain and immediately blamed your low back?  Me too!  Many patients (and unfortunately, many doctors) conclude this to be “sciatica” or a “pinched nerve.”  When this diagnosis is wrong, it can lead to an inappropriate type of treatment, delaying appropriate care, or worse, it may result in death due to a missed diagnosis of a blood clot.  There is currently a government campaign seeking to warn the public about this hard-to-diagnose ‘silent killer.’

Here’s the news flash that was recently released (updated 8:28 a.m. CT, Mon., Sept. 15, 2008):

“WASHINGTON - Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.”

“It’s a silent killer. It’s hard to diagnose,” said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. “I don’t think most people understand that this is a serious medical problem or what can be done to prevent it.”

Blood clots make headlines when seemingly healthy people collapse after prolonged sitting, such as long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the Iraq invasion.

According to the Surgeon General’s new campaign, there are about 100,000 deaths associated with blood clots each year. Risk factors include increasing age (especially over 65), recent surgery or fracture, falls, car crashes, prolonged bed rest, smokers, obesity, pregnancy, and hormone replacement drugs including birth control pills. Other less controllable causes can include genetic conditions so it is important to tell your doctor if a relative has ever suffered a blood clot.

People with these factors should have “a very low threshold” for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a “call to action” for better education of both consumers and doctors, plus more research.

Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.  Unfortunately, studies suggest only a third of patients who need protective blood thinners for major surgery get them. And patients can even be turned away despite telltale symptoms, like what happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn. In her case, after being turned down by several visits to the doctor and ER, only after a very hot bath did her leg swell to 3-4 times its normal size, tipping off the doctors to make the right diagnosis.

Don’t wait for your medical doctor or our office to make the diagnosis if you’re suspicious of a blood clot.  Ask us if it’s a possibility. Rest assured that we have been properly trained to diagnose this condition and we work with other health care providers when needed.

Low Back Pain And Its Many Causes!!!

Low Back Pain And Its Many Causes!!!
Low back pain (LBP) is one of the most common complaints presenting to our office and remains one of the most challenging conditions to manage because there are so many causes of LBP.  Some of the causes include the obvious such as over lifting, over use activities such as sports injuries (bowling, golfing, skiing, tennis, football, etc.), raking leaves, shoveling snow, and more.  Frequently, work related strains are the primary cause of LBP due to the constant, persistent and awkward positions frequently required in many jobs, especially in repetitive motion assembly line work.

The cause can also be as simple as standing on 2 feet vs. 4 feet.  Studies show when 2 legged and 4 legged animals are compared, arthritis starts in the 3rd vs. the 6th decade of life, respectively due to the vertical load placed on the biped or 2-legged animal. In spite of this, after sharing this information with patients, I have not been successful in convincing them to start walking on all fours!  Because we are a 2-legged species, addressing a short leg can have significant benefits to any spinal condition.  This is because a short leg of only 5mm (1/4 inch) can result in a drop in the pelvis resulting in crooked foundation that the spine sits on, creating a curvature in the spine.  This places stress on the spinal components including the spinal cord and nerves and can contribute or be the actual cause of not only LBP, but also problems higher in the spine including neck pain and headaches!

Many times, a satisfying outcome is not achieved until I address the leg length issue by the use of heel or a combination of heel & sole lifts.  If a leg is short, the effects at the top – that is, the neck and head, are dramatically affected.  In one case, treatment to the neck and head had little effect on his headaches and only after placing a heel lift in one shoe and arch support in both shoes did he feel significantly improved.

In most cases, treatment addressing the entire body from the feet up yields the most satisfying results.  Also, secondary issues such as diet, stress management, home treatments including exercises, can be very important in the successful management of back pain.  In many patients, a combination of chiropractic, leg length correction, and nutritional management including the use of vitamin and herbs resulted in the best approach results.

Usually, offering the patient advice on the methods of applying ice, modifying/reducing bending/ lifting activities, as well as performing the chiropractic treatment will satisfy the majority of patients. However, in some cases, co-management with other allied health care providers is necessary, especially where there is a slow response in the initial acute stage of LBP. If these less common cases should occur, the combination of chiropractic and primary care yields the best results.

In our clinic, we offer a multidimensional, holistic approach to the treatment of low back pain so that a positive, satisfying outcome is achieved.

The Difference in Effectiveness of Medical vs. Chiropractic Treatment in Acute and Chronic Back Pain

The Difference in Effectiveness of Medical vs. Chiropractic Treatment in Acute and Chronic Back Pain
Have you ever considered who is the best suited to treat back pain?  Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.  To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention.  Over a 4-year time frame, 2780 patients were followed (initial, 2-week, 1, 3, 6, 12, 24, and 48 month intervals) with questionnaires.  Both acute (symptoms 7weeks) low back pain (LBP) patients were treated using conventional approaches by both the MDs and the DCs.  Treatments from the chiropractors included spinal manipulation, physical therapy, an exercise plan, and self-care education.  Medical therapies included prescription drugs, an exercise plan, self-care advice and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires that were mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:



Pain relief in the first 12 months (more evident in the chronic patients)
When LBP pain radiated below the knee (more evident in the chronic patients)
Chronic LBP patients with no leg pain (during the first 3 months)


Similar trends favoring chiropractic were seen for disability but were of smaller magnitude.  All patient groups saw significant improvement in both pain and disability over the four year study period.  Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.  Noteworthy, at the 3 year point, ½ to ¾ of all the patients reported at least 30 days of pain during the prior year including those that responded well after early treatment.  Also, 19 to 27% of chronic LBP patients noted daily pain during the prior year.  This suggests that LBP is more likely to return at times in the future, which many have similarly reported to be true.

However, this study also found that early intervention reduced chronic pain and, at year 3, those acute LBP patients that received early intervention reported fewer days of LBP that those that waited longer for treatment.  While both MDs and DCs treatment approaches helped, it’s quite clear from the information reported that chiropractic treatment approaches should be utilized first.

These findings support the importance of early intervention by chiropractic physicians makes the most sense for those of you struggling with the question of who to see for your LBP.

Does The Use Of A Low Back Support Or Brace Really Make A Difference?

Does The Use Of A Low Back Support Or Brace Really Make A Difference?
“Do you think a back brace will help my condition?”  This is a question that is frequently asked of many health care providers who treat low back pain.  The answers typically vary, as there is support for and against the use of a brace when low back pain is present.  In a Feb. 2009 study, the use of an elastic lumbar belt was studied in a group of subacute low back pain patients for its effect on functional capacity (lift and carry types of activities), pain intensity, and the effects on health care service costs.  This study was unique in that it was carried out in several different locations and, the patients were randomized and received either a lumbar belt or nothing (“control group”). 197 patients were included in the study, which is a good sample size for research purposes.  The results of the study, at the end of 90 days, revealed a higher score for the back brace treated group than the non-braced control group.  The pain scale improved greater in the brace treated group as an improvement of 42 points vs. 32 points was reported.  Similarly, 61% in the brace treated group used no medication compared to 40% in the non-braced group.  It was concluded that patients with subacute low back pain improved significantly in functional status, pain reduction and medication utilization.

The use of back braces has been considered a “standard” in the treatment of patients with LBP for many years. One argument against using back braces centers around becoming “dependant” either physically or mentally on its use and this has long been a concern amongst health care providers.  For most patients, this is not a concern as most do not “enjoy” the use of a brace and they look forward to discontinuing their use of it.  Braces are particularly helpful when the patient cannot stop performing needed activities, such as work.  This is especially true for farmers who have to tend to the animals and crops during planting, cultivating and harvest times of the year.  In addition, single moms or dads who have to go to work in order to provide for their children are driven to stay on the job.  In these cases, the use of a back brace can be of utmost importance.

There are many types of back braces.  Some are narrow and are particularly favored when frequent bending and/or twisting movements are required by a job, sport, or other daily activity. Other braces are taller in the back and taper in the front, which give better support but still allow some bending / twisting movements.  Some braces are more rigid and can actually stop movement in certain directions.  These types include a hard, rigid surface that is placed in the area of the back where movement is not desired.  These are used at times when there are fractures of the spine, after spinal surgery and in scoliosis bracing. Some braces are to be worn low on the pelvis to support that area, while most are placed in the center of the low back region.  There are also rib belts sometimes used when ribs fracture, soft and rigid neck braces sometimes used after car accidents, and braces for the arms or legs.  The decision to use a brace rests on the degree of injury and the patient’s ability to avoid certain activities or positions.  When the injury is significant and/or the patient cannot control his/her activities (such as work), then the use of a brace may be one of the most important treatment approaches for that patient.  It’s similar to having stitches when a deep or wide cut occurs.  Ask us about the use of supports, braces, or belts if you or your family or friends are suffering with low back pain.

What Makes Back Pain So Common?

What Makes Back Pain So Common?
Low back pain (LBP) is one of the most common types of pain involving the musculoskeletal system.  LBP sufferers may sometimes miss work or be unable participate in desired activities, social outings, and the like.  It can be so disabling that out of desperation, they visit the ER.

There are many causes of LBP. Some of the obvious include over lifting/carrying, performing a task for too long or with too many repetitions, and sitting or standing in one position for too long.  However, frequently LBP seems to occur for no apparent reason, or at least none that can be clearly identified.  One of the most basic causes of LBP is simply standing on two, rather than four legs.  When comparing a 4-legged to a 2-legged subject, arthritis of the spine and disc degeneration occurs much earlier in those of us with two legs.  This is due partially because 2/3rds of our weight is supported by the low back and pelvis.  In addition, vertical loading occurs in the 2-legged subject whereas the load is distributed between four legs in a horizontal fashion in the 4-legged species.  Other less obvious causes of LBP include physical characteristics such as flat feet (fallen arches), a short leg resulting in a tipped pelvis, carrying too much weight, being out of shape/weak muscles, as well as hereditary factors.  Non-physical characteristics include diet, exercise participation, lifestyle, stress and other psychological conditions such as depression, anxiety, bipolar disorders, and others.  Hence, treatment must address the entire person, not just the low back since often, several of the characteristics mentioned here are present and often participating in the cause for LBP.

Because many of these characteristics are not properly attended to, LBP tends to be recurrent, where multiple episodes come and go over time.  In years past, health care providers would focus the majority of their attention on the physical characteristics of LBP and when treatment results was ineffective, the blame was placed on the psychological aspects for which little, if any, treatment was offered.  However, over the last 20 years, the shift towards treating the whole person or, adopting the biopsychosocial model (bio- = physical, psycho- = mental, and social = how LBP is perceived and affects daily social interaction) has been emphasized as the appropriate approach when managing patients with low back pain.  No longer should the psychological aspect be ignored but rather, identified and treated so that this significant barrier to recovery can be properly managed.

Regarding treatment, unless someone presents with a “red-flag” which, for LBP sufferers include cancer, fracture (especially unstable fractures), cauda equine syndrome (spinal cord pinching resulting in bowel / bladder control loss), or infection, immediate/emergent care is not required. A careful health history followed by appropriate tests can usually identify these “red flags.”  Otherwise, surgery for LBP is not recommended until at least 4-6 weeks of treatment with non-surgical approaches are first utilized and, an identifiable “lesion” can be identified that clearly is causing the presenting complaints and clinical findings.  Chiropractic has an obvious advantage over specialty care when considering non-surgical treatment of LBP.  Both physical and emotional issues are identified and a “team” approach with other health care providers when required is ordered.  Moreover, all the international guidelines published for treating LBP recommend spinal manipulation BEFORE most of the other non-surgical approaches are tried due to medication side-effects and, the successes reported in many studies where spinal manipulation is performed.

Low Back Pain and the Hamstrings

Low Back Pain and the Hamstrings
Have you ever considered how important your hamstrings muscles are in relationship to the low back?  Most people do not think about those tight muscles on the back of the upper leg / thigh as having much to do with low back pain (LBP).  However, it is one of the most important muscles groups to keep loose both as a means of improving current low back trouble as well as preventing future LBP.  Think of the hamstrings as a stabilizing guide wire that keeps us upright.  When we bend over with our knees straight, we can feel the hamstrings gradually tighten, often limiting us from reaching our toes.  When the hamstrings are too tight, some of us can hardly reach past our kneecaps as we bend over.  We then (unconsciously) bend our knees to put slack in the hamstrings so we can easily reach the floor.

The low back is only so flexible and in reality, most of our ability to touch our toes comes from our hip joints.  In fact, after scoliosis surgery where metal rods are placed on both sides of the spine, these patients will often make up for the loss of low back movement by increasing hip motion and still be able to touch their toes!  This, however, can only be accomplished if the hamstrings are stretched to a point of allowing the hips and pelvis to rotate forwards when bending with the knees straight.

So, what happens if the hamstrings are too tight?  Think of a young sapling tree branch versus an old oak branch. When bending the two branches, the young sapling can easily bend, while the old oak branch breaks early into the process.  Similarly, as we bend over to lift a box, when the back and leg muscles, ligaments, and tendons are tight, something has to give or “break,” similar to the old oak branch. The “weak link” in the injured person bending over may be a disc that ruptures, ligaments and/or muscle tendons that overstretch and tear.  By keeping the hamstrings loose (like the young sapling branch), much less force is placed on the spine because the pelvis can rock forwards during the bending process, thus unloading the spine.  Another way to look at it is that when the hamstrings are too tight, something else has to be correspondingly loose to make up for the tight hamstrings or else the task of bending forwards and performing daily tasks will be limited.

Tissues in our back are injured when forces exceed their capacity to withstand the load.  By keeping our hamstrings stretched, we reduce the need for our spine to have to make up for the tightness; thus both preventing a new injury, as well as perpetuating a current problem.  The best way stretch the hamstrings is to lay on our back in an open doorway with one leg placed on the door jamb (edge of the doorway) and the other leg is kept flat on the floor (knee straight) through the door opening. Scoot as close as you can so that the hamstring muscles are stretched tightly to the point of a “good hurt.”  Maintain that position for at least 2 minutes and then switch legs.  Because the hamstrings tighten up during sleep, it’s usually best to perform the stretch in the morning.  Repeating this multiple times a day may be required to obtain proper hamstring muscle length.  Exercise training is a routine part of chiropractic care!

If you, your family, or a friend is struggling with low back pain, sharing this information may be one of the greatest acts of kindness you can give to that person. At this clinic, we strive to provide the highest quality care and follow evidence and “best practice” approaches.  We greatly appreciate the trust that our patients place in us and our services as we help them recover as well as teach ways to prevent future LBP episodes.