Did you know that sleeping on your back puts approximately 50 pounds of pressure on your spine?
Other positions, such as a side position, may be better.
Low Back Pain
Condition Of The Month: Pregnancy-Related Low Back Pain
Low back pain during pregnancy is quite common. In fact, between 50-75% of all pregnant women will experience low back pain. The pain is usually caused from rapid changes in weight, posture, gait and hormones.
The average woman gains between 20-40 pounds throughout pregnancy. This weight gain moves your center of gravity forward, causing your pelvis to tilt and your lower back to sway – placing excessive stress on the ligaments, discs, and joints of your spine.
Pregnancy-related low back pain typically starts between the fifth and seventh month of pregnancy, although a significant portion of women experience pain sooner. Symptoms often begin at the base of your spine and may radiate into your buttock or thigh. Discomfort is often aggravated by prolonged standing, sitting, coughing, or sneezing. Your symptoms may increase throughout the day, and some patients report nighttime pain that disturbs their sleep. The extremes of activity seem to contribute to pregnancy-related low back pain – with increased risk for both “sedentary” and “physically demanding” lifestyles. Patients who have suffered with back pain prior to pregnancy are more than twice as likely to re-develop back pain during pregnancy.
Be sure to tell your doctor if your symptoms include fever, chills, bleeding, spotting, unusual discharge, cramping, sudden onset pelvis pain, light-headedness, shortness of breath, chest pain, headache, calf pain or swelling, decreased fetal movement, or symptoms that radiate beyond your knee.
Unfortunately, pregnancy related low back pain occurs at a time when your medical treatment options are limited. Not surprisingly, over 90% of prenatal health care providers would recommend drug-free treatment, including the type of alternative therapy provided in this office. Studies have shown that chiropractic manipulation provides significant relief of pregnancy- related low back pain. Almost 75% of women undergoing chiropractic care report significant pain reduction with improved ability to function.
Most patients will also benefit from continuing aerobic exercise throughout pregnancy. The US Department of Health and Human Services advises that healthy pregnant women may begin or continue moderate intensity aerobic exercise for at least 150 minutes per week. Women should not begin “vigorous” exercise during pregnancy, but those who were preconditioned to vigorous exercise may continue. Be sure to check with your doctor prior to initiating or increasing any exercise program while you are pregnant.
Be sure to take frequent breaks from prolonged sitting or standing. You may find benefit by using a small footstool to alternate feet while standing. Sleeping with a pillow between the knees in a side lying posture may help you to rest more comfortably. You should wear shoes with good arch supports. In some cases, your chiropractor may recommend a sacroiliac belt or pelvic support belt to help relieve your pregnancy-related low back pain.
10 Quick Back Pain Tips
Low back pain (LBP) is VERY likely to affect all of us at some point in life. The question is, do you control IT or does IT control you? Here are ten “tricks” for staying in control of “IT!”
1) STRETCH: When you’re in one position for a long time (like sitting at your desk), SET your cell phone timer to remind yourself to get moving and stretch every 30-60 minutes! Mornings are a great time to stretch.
2) BE SMART: Do NOT place your computer monitor anywhere other than directly in front of you. Shop carefully for a GOOD supportive office chair that is comfortable and a good fit.
3) POSTURE: For sitting, sit as upright as comfortably possible keeping your chin tucked in so the head stays back over the shoulders.
4) SHOE WEAR: Avoid wearing heels greater than one inch high (2.54 cm). A supportive shoe that can be worn COMFORTABLY for several hours is ideal! Generally, the “skimpier” the shoe, the worse the support, so don’t “skimp” on shoe wear!
5) SMOKING: Carbon monoxide from cigarette smoke competes with oxygen at each cell in the body literally suffocating them, which makes the healing process more difficult.
6) WEIGHT: Your body mass index (BMI) should be between 18.5 and 25. Search the internet for “BMI Calculator” and plug in your height and weight to figure out yours. BMI is a reliable indicator of body fatness and a great way to determine where you are at for goal setting.
7) ANTI-INFLAMMATION: Common over the counter (OTC) medications include ibuprofen and naproxen. However, recent studies show these types of medications (NSAIDS) may delay the healing process. A healthier choice is ginger, turmeric, and bioflavonoids, which are commonly bundled together in a supplement. Eat fresh fruits, veggies, lean meats, and food rich in omega-3 fatty acids. Vitamin D, magnesium, and coenzyme Q10 are also smart choices. AVOID FAST FOOD as they tent to be rich in omega-6 fatty acids, which can promote inflammation.
8) ICE: This could be included in #7 but deserves its own space. Ice reduces swelling while heat promotes it. Try rotations of ice every 15-20 minutes for about an hour three times a day to “pump” out the swelling!
9) STAY ACTIVE: Balance rest with physical activity like exercise or simply going for a walk. The most important thing is to move your body around.
10) STRENGTHEN: Core stabilizing exercises (sit-ups, planks, quadruped) and BALANCE exercises are VERY important!
Where is my Low Back Pain coming from?
Most of us have suffered from back pain at one time or another. It often occurs after over-doing a physical task, like fall yard work, winter snow shovelling, working on the car, cleaning the house, and so on. But there are times when identifying the cause of back pain can be difficult or impossible. Let’s take a deeper look at where back pain can come from…
Though activity-related back pain is common, many times a direct link to over-use is not clear. Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. (Think of the old adage “The straw that broke the camel’s back.”)
There are other less well-identified causes of back pain. One is called referred pain. This can be caused by an irritated joint or soft tissue not necessarily located in the immediate area of the perceived pain. For example, pain in the leg can result from an injured facet joint, sacroiliac joint, and/or a disk tear (without nerve root pinch). This is called “sclertogenous pain.”
Internal organs can also cause back pain. This is called a “viscerosomatic response” (VSR). A classic example of this is when the right shoulder blade seems to be the source of pain when the gall bladder is inflamed. This pain can be located at or below the scapula next to the spine and the muscles in the area are in spasm and sensitive or painful to the touch. Also, VSR is often not worsened or changed by bending in different directions (unlike musculoskeletal / MSK pain). Without further testing, it’s easy to confuse this with a MSK or a “typical” back ache. Ultimately, a final diagnosis may require an abdominal ultrasound (CT, MRI scan, and other diagnostics are less frequently used).
Visceral pathology in the back pain patient presenting to chiropractors is reportedly rare, and according to one survey, only 5.3% of patients present with non-musculoskeletal complaints. Other common VSR pain patterns are as follows: Heart – left chest to left arm, mid-upper back, left jaw; Liver – right upper shoulder (front and back), right middle to low back, and just below the sternum; Appendix – right lower abdomen (may start as stomach pain); Small intestine – either side of the umbilicus and/or between it and the breast bone; Kidney – small of the back, upper tailbone, and/or groin area; Bladder – just above the pubic bone and/or bilateral buttocks; Ovaries – groin and/or umbilical area; and Colon – mid-abdominal and/or lower quadrants.
Another challenge to diagnosis is cancer in the spine, which can be primary or metastatic (from a different location). Thankfully, this is very rare. A history of unexplained weight loss, a past history of cancer, over age 50, nighttime sleep interruptions, and no response to usual back care may lead a doctor to recommend tests to determine if cancer is present in the spine.
Bottom line: When patients present with back pain, chiropractors have been trained to look for these less common but important causes of back pain. They get “suspicious” when the “usual” orthopedic tests do not convey the usual responses seen with mechanical back pain. In these cases, they work with primary care doctors to coordinate care to obtain prompt diagnostic testing and treatment.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
I love this video
There is a lot to be learnt from this video. Dr. Mike Evans does a great job of explaining why we need to KEEP MOVING during and after an episode of low back pain. Check it out!
Exercise of the Month!
One of our favourites in the office; Thoracic Rotation.
An easy exercise for your upper and mid-back. No equipment required! – (Post link to article and video on your blog or post video directly on your social media account.)”
- Begin on your hands and knees and shift back so that your buttock is on your heels.
- Place one hand behind your neck with your elbow pointing downward.
- Rotate your trunk to move your elbow towards your opposite knee.
- Rotate back, raising your elbow toward the ceiling.
- Repeat three sets of 10 repetitions on each side twice per day or as directed.
Reasons You’re Suffering From Back Pain (Besides Sitting All Day)
Some things to consider if you’re suffering from back pain.
Reasons you’re probably suffering from back pain (besides sitting all day)
Exercise Helps LBP!
Moving is good for your back and muscles, especially if you have back pain. Check out this link for more info!
http://www.theitem.com/stories/exercise-to-help-relieve- your-lower-back-pain,296073
PFPS Cont. You want details?
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)
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)
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.
What the heck is a trigger point?
By Bryan Cobb, Advanced Remedial Massage Therapist
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.
Aberdeen Chiropractic 