Low Back Pain

Put the shovel down and read this!

~ Dr. Robert Speirs DC ~ Leave a comment

Your low back consists of 5 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is a tough ligament that wraps around the inner nucleus much like a ribbon wrapping around your finger.
Your low back relies on discs and other ligaments for support. “Discogenic Low Back Pain” develops when these tissues are placed under excessive stress, much like a rope that frays when it is stretched beyond its normal capacity. Most commonly, disc pain is not the result of any single event, but rather from repeated overloading. Your lumbar discs generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Approximately one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems.

Symptoms from disc pain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Repeated injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” Over time, discs may dehydrate and thin. This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. Light aerobic exercise (i.e. walking, swimming, etc) has been shown to help back pain sufferers. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes.

What Causes Low Back Pain?

~ Dr. Robert Speirs DC ~ Leave a comment

​236

Low back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues.
To simplify the task of determining “What is causing my LBP?” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly managed by chiropractors.
Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results.
Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve root-related LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg.
The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “micro-traumas” extending back in time that may be the “cause” of their current low back pain issues.
Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on—possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb.
Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.

Hamstring Problems?

~ Dr. Robert Speirs DC ~ Leave a comment

Glute Ham Raise.gif

A great injury prevention movement is the glute-ham raise. Done after a warm up and prior to competition it will significantly reduce the odds of hamstring strains in running athletes in sports like Soccer, Football and Sprinting.

To perform the movement:

Begin in a tall kneeling position on a cushion or pillow.

Partner grabs and holds ankles to ground or hook your feet under a stable surface.

Keeping your torso neutral and your thighs in line with your body, bend forward at the knees, using your hamstrings to control the speed of your forward bend.

Go as far as you can without cramping, pain or falling to the ground.

 

“Other” Causes of Low Back Pain

~ Dr. Robert Speirs DC ~ Leave a comment

316046269_1280x720​

Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.

The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!

My Hip Hurts….

~ Dr. Robert Speirs DC ~ Leave a comment

hip FAI

​Is it a labral tear? 

One of the structures that is frequently blamed for hip pain is called the labrum—the rubbery tissue that surrounds the socket helping to stabilize the hip joint. This tissue often wears and tears with age, but it can also be torn as a result of a trauma or sports-related injury.

The clinical significance of a labral tear of the hip is controversial, as these can be found in people who don’t have any pain at all. We know from studies of the intervertebral disks located in the lower back that disk herniation is often found in pain-free subjects—between 20-50% of the normal population.  In other words, the presence of abnormalities on an MRI is often poorly associated with patient symptoms, and the presence of a labral tear of the hip appears to be quite similar.

For instance, in a study of 45 volunteers (average age 38, range: 15–66 years old; 60% males) with no history of hip pain, symptoms, injury, or prior surgery, MRIs reviewed by three board-certified radiologists revealed a total of 73% of the hips had abnormalities, of which more than two-thirds were labral tears.

Another interesting study found an equal number of labral tears in a group of professional ballet dancers (both with and without hip pain) and in non-dancer control subjects of similar age and gender.

Another study showed that diagnostic blocks—a pain killer injected into the hip for diagnostic purposes to determine if it’s a pain generator—failed to offer relief for those with labral tears.

Doctors of chiropractic are trained to identify the origins of pain arising from the low back, pelvis, hip, and knee, all of which can mimic or produce hip symptoms.  Utilizing information derived from a careful history, examination, imaging (when appropriate), and functional tests, chiropractors can offer a nonsurgical, noninvasive, safe method of managing hip pain.

What the heck is a trigger point?

~ Dr. Robert Speirs DC ~ Leave a comment

trigger-point-referred-pain-shutterstock_228843211

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce, at some time in your life.

TP’s were first brought to the attention of the medical world by Dr. Janet G. Travell. Dr. Travell, physician to President John F. Kennedy, is the acknowledged Mother of Myofascial Trigger Points. In fact, “Trigger Point massage, the most effective modality used by massage therapists for the relief of pain, is based almost entirely on Dr. Travell’s insights.”2 Dr. Travell’s partner in her research was Dr. David G. Simons, a research scientist and aerospace physician.

Trigger Points are very common. In fact, Travell and Simons state that TP’s are responsible for, or associated with, 75% of pain complaints or conditions.1 With this kind of prevalence, it’s no wonder that TP’s are often referred to as the “scourge of mankind”.

Trigger Points can produce a wide variety of pain complaints. Some of the most common are migraine headaches, back pain, and pain and tingling into the extremities. They are usually responsible for most cases of achy deep pain that is hard to localize.

A TP will refer pain in a predictable pattern, based on its location in a given muscle. Also, since these spots are bundles of contracted muscle fibres, they can cause stiffness and a decreased range of motion. Chronic conditions with many TP’s can also cause general fatigue and malaise, as well as muscle weakness.

Trigger Points are remarkably easy to get, but the most common causes are

TP’s (black X) can refer pain to other areas (red)

Sudden overload of a muscle

  • Poor posture
  • Chronic frozen posture (e.g., from a desk job), and
  • Repetitive strain

Once in place, a TP can remain there for the remainder of your life unless an intervention takes place.

Trigger Points Not Well Known

With thousands of people dealing with chronic pain, and with TP’s being responsible for — or associated with — a high percentage of chronic pain, it is very disappointing to find that a large portion of doctors and other health care practitioners don’t know about TP’s and their symptoms.

Scientific research on TP’s dates back to the 1700’s. There are numerous medical texts and papers written on the subject.

But, it still has been largely overlooked by the health care field. This has led to needless frustration and suffering, as well as thousands of lost work hours and a poorer quality of life.

How Are Trigger Points Treated?

As nasty and troublesome as TP’s are, the treatment for them is surely straight-forward. A skilled practitioner will assess the individual’s pain complaint to determine the most likely location of the TP’s and then apply one of several therapeutic modalities, the most effective of which is a massage technique called “ischemic compression”.

Basically, the therapist will apply a firm, steady pressure to the TP, strong enough to reproduce the symptoms. The pressure will remain until the tissue softens and then the pressure will increase appropriately until the next barrier is felt. This pressure is continued until the referral pain has subsided and the TP is released. (Note: a full release of TP’s could take several sessions.)

Other effective modalities include dry needling (needle placed into the belly of the TP) or wet needling (injection into the TP). The use of moist heat and stretching prove effective, as well. The best practitioners for TP release are Massage Therapists, Physiotherapists, and Athletic Therapists. An educated individual can also apply ischemic compression to themselves, but should start out seeing one of the above therapists to become familiar with the modality and how to apply pressure safely.

1 Simons, D.G., Travell, D.G., & Simons, L.S. Travell and Simons’Myofascial Pain and Dysfunction: the Trigger Point Manual.

Vol. 1. 2nd ed. Lippincott, Williams, and Wilkins, 1999.

PFPS Cont. You want details?

~ Dr. Robert Speirs DC ~ Leave a comment

Screen Shot 2017-10-31 at 11.15.32 AM.png

The muscles of the hip provide not only local stability, but also play an important role in spinal and lower extremity functional alignment. (1-4) While weakness in some hip muscles (hip extensors and knee extensors) is well tolerated, weakness or imbalance in others can have a profound effect on gait and biomechanical function throughout the lower half of the body. (5) Weakness of the hip abductors, particularly those that assist with external rotation, has the most significant impact on hip and lower extremity stability. (5,6)

Hip Abduction.gif

The gluteus medius is the principal hip abductor. When the hip is flexed, the muscle also assists the six deep hip external rotators (piriformis, gemelli, obturators, and quadratus femoris). The gluteus medius originates on the ilium just inferior to the iliac crest and inserts on the lateral and superior aspects of the greater trochanter. While the principal declared action of the gluteus medius is hip abduction, clinicians will appreciate its more valuable contribution as a dynamic stabilizer of the hip and pelvis- particularly during single leg stance activities like walking, running, and squatting. The gluteus medius contributes approximately 70% of the abduction force required to maintain pelvic leveling during single leg stance. The remainder comes predominantly from 2 muscles that insert onto the iliotibial band: the tensor fascia lata and upper gluteus maximus.  Hip abductor strength is the single greatest contributor to lower extremity frontal plain alignment during activity. (6)

Screen Shot 2017-10-31 at 11.12.00 AM

Incompetent hip abductors and/or external rotators allows for excessive adduction and internal rotation of the thigh during single leg stance activities. This leads to a cascade of biomechanical problems, including pelvic drop, excessive hip adduction, excessive femoral internal rotation, valgus knee stress, and internal tibial rotation. (1,7-12)

 

References
1. Szu-Ping Lee, Powers C. Description of a Weight-Bearing Method to Assess Hip Abductor and External Rotator Muscle Performance. JOSPT. Volume 43, Issue 6
2. Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39:866-873.
3. Presswood L, Cronin J, Keogh JWL, Whatman C. Gluteus medius: applied anatomy, dysfunction, assessment, and progressive strengthening. Strength Cond J. 2008;30:41-53.
4. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor ex- ercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Phys Ther. 2010;90:895-904.
5. van der Krogt MM, Delp SL, Schwartz MH How robust is human gait to muscle weakness? Gait Posture. 2012 Feb 29.
6. Laurie Stickler, Margaret Finley, Heather Gulgin Relationship between hip and core strength and frontal plane alignment during a single leg squat Physical Therapy in Sport Available online 2 June 2014
7. Ireland ML, Willson JD, Ballantyne BT, Davis
IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33:671-676.
8. Noehren B, Davis I, Hamill J. ASB clinical biome- chanics award winner 2006: prospective study of the biomechanical factors associated with iliotib- ial band syndrome. Clin Biomech (Bristol, Avon). 2007;22:951-956.
9. Powers CM. The influence of abnormal hip me- chanics on knee injury: a biomechanical perspec- tive. J Orthop Sports Phys Ther. 2010;40:42-51.
10. Powers CM. The influence of altered lower- extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33:639-646.
11. Sigward SM, Powers CM. Loading characteristics of females exhibiting excessive valgus moments during cutting. Clin Biomech (Bristol, Avon). 2007;22:827-833
12. Souza RB, Powers CM. Differences in hip kine- matics, muscle strength, and muscle activation between subjects with and without patellofemo- ral pain. J Orthop Sports Phys Ther. 2009;39:12- 19.

Exploring the Link Between Chiropractic Care and Pain Relief

~ Dr. Robert Speirs DC ~ Leave a comment

Pain is a universal experience that can significantly impact our quality of life, mobility, and overall well-being. While pain management often involves medication or surgery, many people are turning to chiropractic care as a natural and holistic approach to pain relief. In this article, we’ll delve into the connection between chiropractic care and pain relief and explore how chiropractic treatments can help alleviate various types of pain.

Understanding Chiropractic Care

Chiropractic care is a branch of alternative medicine that focuses on the diagnosis, treatment, and prevention of musculoskeletal disorders, particularly those affecting the spine. Chiropractors use hands-on techniques, such as spinal adjustments, manipulations, and soft tissue therapies, to realign the spine, improve joint mobility, and restore proper function to the nervous system.

The Role of Chiropractic Care in Pain Relief

Chiropractic care is widely recognized for its effectiveness in relieving pain, particularly in the back, neck, and joints. Here’s how chiropractic treatments can help alleviate pain:

  1. Spinal Alignment: Misalignments or subluxations in the spine can put pressure on nerves, leading to pain and discomfort. Chiropractic adjustments aim to correct these misalignments, restore proper alignment to the spine, and alleviate nerve compression, resulting in pain relief and improved mobility.
  2. Reduction of Inflammation: Chiropractic adjustments can help reduce inflammation in the body by improving joint function, increasing blood flow, and promoting the release of anti-inflammatory substances. By addressing the underlying cause of inflammation, chiropractic care can help alleviate pain associated with conditions such as arthritis, bursitis, and tendonitis.
  3. Muscle Relaxation: Chiropractic treatments often involve soft tissue therapies, such as massage, myofascial release, and trigger point therapy, which help relax tense muscles, reduce muscle spasms, and improve circulation. By addressing muscular imbalances and tension, chiropractic care can alleviate pain and stiffness in the muscles and surrounding tissues.
  4. Prevention of Recurring Pain: In addition to providing immediate pain relief, chiropractic care focuses on addressing the underlying causes of pain and dysfunction to prevent future episodes of pain and discomfort. Through regular chiropractic adjustments, lifestyle modifications, and rehabilitative exercises, chiropractors help patients maintain optimal spinal health and function, reducing the risk of recurring pain.

Conditions Treated by Chiropractic Care

Chiropractic care can effectively treat a wide range of acute and chronic pain conditions, including:

  • Back pain (lower back pain, upper back pain)
  • Neck pain
  • Headaches and migraines
  • Joint pain (shoulder pain, hip pain, knee pain)
  • Sciatica
  • Herniated discs
  • Fibromyalgia
  • Sports injuries
  • Carpal tunnel syndrome

Conclusion

Chiropractic care offers a safe, natural, and drug-free approach to pain relief that focuses on addressing the underlying causes of pain and dysfunction. By restoring proper alignment to the spine, optimizing nervous system function, and promoting overall musculoskeletal health, chiropractic treatments can help alleviate pain, improve mobility, and enhance quality of life. If you’re experiencing pain or discomfort, consider consulting with a qualified chiropractor to explore how chiropractic care can help you find relief and restore your health and vitality.

Understanding Piriformis Syndrome: Symptoms, Causes, and Treatment Options

~ Dr. Robert Speirs DC ~ Leave a comment

Piriformis syndrome is a condition where the sciatic nerve is compressed as it passes underneath a muscle in your buttock called the piriformis. This muscle attaches from the sacrum (the lowest part of your spine) and extends across to your hip, helping to rotate your leg outward when it contracts. For most people, the sciatic nerve travels deep beneath the piriformis muscle. However, if the piriformis muscle becomes irritated or goes into spasm, it can cause painful compression of the sciatic nerve. Interestingly, about a quarter of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle rather than underneath it.

Causes of Piriformis Syndrome

Piriformis syndrome can start suddenly due to an injury or develop gradually from repeated irritation. Common causes include:

  • Falls onto the buttocks
  • Catching oneself from a near fall
  • Strains
  • Long-distance walking
  • Stair climbing
  • Sitting on hard surfaces or wallets

In many cases, a specific triggering event cannot be pinpointed. This condition is most common in people aged 40-60 and affects women more often than men.

Symptoms of Piriformis Syndrome

Symptoms of piriformis syndrome include:

  • Pain, numbness, or tingling that begins in the buttock and radiates along the sciatic nerve toward the foot.
  • Symptoms often increase when sitting or standing in one position for more than 15-20 minutes.
  • Changing positions may help alleviate symptoms.
  • Increased discomfort when walking, running, climbing stairs, riding in a car, sitting cross-legged, or getting up from a chair.

Effective Treatments for Piriformis Syndrome

Sciatica arising from piriformis syndrome is one of the most treatable forms of sciatica and generally responds well to the type of treatment provided at our office. Here are some effective treatment options:

1. Chiropractic Adjustments

Chiropractors can perform adjustments to help relieve pressure on the sciatic nerve and improve overall spinal alignment, reducing irritation of the piriformis muscle.

2. Massage Therapy

Massage can help relax the piriformis muscle, reduce spasms, and alleviate sciatic nerve compression.

3. Physical Therapy

Physical therapists can guide you through specific exercises to stretch and strengthen the piriformis muscle and surrounding muscles, promoting better muscle balance and reducing pressure on the sciatic nerve.

4. Acupuncture

Acupuncture can help relieve muscle tension and improve blood flow, reducing pain and promoting healing.

5. Home Care and Exercises

Applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day, can provide relief. Additionally, home stretching exercises are an important part of your recovery. Here are some stretches you can try:

  • Piriformis Stretch: Lie on your back with both knees bent. Cross the affected leg over the other, resting the ankle on the opposite knee. Gently pull the bottom knee toward your chest until you feel a stretch in the buttock.
  • Hamstring Stretch: Sit on the ground with your legs extended straight out. Reach toward your toes, keeping your back straight, until you feel a stretch along the back of your thighs.

Conclusion

Piriformis syndrome can be a painful and debilitating condition, but with proper treatment, it is highly manageable. If you suspect you have piriformis syndrome, consult with a healthcare professional for an accurate diagnosis and personalized treatment plan. At River East Chiropractic, we offer comprehensive care, including chiropractic adjustments, acupuncture, massage therapy, occupational therapy, and access to a full gym, to help you find relief from piriformis syndrome and get back to your favorite activities.

Contact us today to schedule an appointment and start your journey toward a pain-free life. Don’t forget to follow us on social media for more health tips and updates!