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I have Low Back Pain. Why?

~ Dr. Robert Speirs DC ~ Leave a comment

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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.

My Hip Hurts….

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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.

“Other” Causes of Low Back Pain

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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!

Sleep Tips for Fibro 1-5

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In-bed-after-no-sleep

​Last week, we discussed the connection between sleep disturbance and the presence of widespread pain found with fibromyalgia (FM). This month’s topic will center on how we can improve our sleep quality with the goal of feeling restored upon waking in the morning!

1)  NOISE & LIGHT: Block out noise with earplugs or a sound machine and light with window blinds, heavy curtains, and/or an eye mask. The light emanating from the LED or LCD from TVs, DVRs, or stereos has been found to suppress the pineal gland’s melatonin production (the “sleep hormone”) and thus can interfere with sleep, so try to keep them away from the bedroom. However, a small night light can assist for nighttime bathroom callings!

2) FOOD: Avoid large meals at least two hours before bedtime. Try a glass of milk, yogurt, or a small protein snack if hunger overcomes you. Milk is unique as it contains the amino acid L-tryptophan, which studies show, helps people sleep!

3)  EXERCISE: Aerobic exercise during the day is HIGHLY therapeutic. It reduces stress, reduces pain, reduces depression, and wakes us up! Avoid heavy exercise within three hours before bedtime. Exercise on a REGULAR basis to promote high-quality deep sleep.

4)  SLEEP HABITS: Develop good sleeping habits by going to bed at a regular time. Avoid napping in the late afternoon. A “POWER NAP” of no more than 10-15 minutes, ideally about eight hours after waking, is a GOOD THING as it can help you feel refreshed.

5)  MENTAL TASKS: Avoid mentally stimulating activity one hour before bedtime to calm the brain.

 

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Migrane Control? How?

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Migrane

​Migraines can be life-altering! They can stop us from being able to enjoy a child’s piano recital, participate in family events, go to work, or simply do household chores! Wouldn’t it be nice to have ways to self-manage these miserable, often disabling headaches? Here are some options!

1. RELAXATION THERAPY: Search for a calm environment, turn off the lights (photophobia, or light sensitivity, is a common migraine complaint), minimize sound/noise (due to “hyperacusis”), and sleep if possible. Monitor the room temperature and/or use hot/cold compresses to the head and/or neck regions to relax tight muscles (heat) and reduce pain and swelling (cold). Similarly, a warm shower or bath can have similar beneficial effects.

2. SLEEP WELL: Migraines can interfere with falling asleep, they can wake you up during the night, and they are often triggered by NOT getting a good night’s sleep. To improve your sleep quality: a) Establish regular sleeping hours. Wake up and go to bed at consistent times every day, including weekends. b) Keep daytime naps short (20-30 min. max). c) “Unwind” at the end of the day – try soothing music, a warm bath, or reading a favorite book (avoid suspenseful movies). d) Don’t eat/drink too much before bedtime as heavy meals, caffeine, nicotine, and alcohol can interfere with sleep. e) Don’t exercise intensely before bedtime (stretching is fine). f) Eliminate distractions in the bedroom, including TV and bringing work to bed. Close the bedroom door and use a fan to muffle out distracting noises. g) If you take any medications, check for known side effects, as many contain caffeine or other stimulants that can interfere with sleep – including some meds that treat migraines! Talk to your doctor and pharmacist!

3. EAT WELL: Be consistent about when you eat and don’t skip meals (fasting increases the risk for migraine). Keep a food journal to figure out your migraine triggers and avoid foods that commonly trigger migraines like chocolate, aged cheeses, caffeine, and alcohol. Try eliminating these and see how you feel!

4. EXERCISE REGULARLY:  This is MOST IMPORTANT for migraine management as it facilitates sleep cycles and stimulates the release of endorphins and enkephlins that help block pain. It also helps fight obesity, which is another risk factor for headaches.

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 neck pain or headaches, we would be honored to render our services.

CTS Exercises?

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​CTS Stretch

Carpal Tunnel Syndrome (CTS) is the leading cause of numbness to the middle three fingers and thumb and affects millions of Americans each year. There are MANY potential causes of CTS, and these causes can be unclear or multi-factorial. We have discussed the importance of night splints and what chiropractic can do for CTS in the recent past. This month, let’s look at what YOU can do for CTS.
“Self-help” concepts are VERY important as they empower YOU to gain control of your condition’s signs and symptoms, thus placing less reliance on those of us who manage (in this case) CTS. There is a time for “PRICE” or, Protect, Rest, Ice, Compress, Elevate, such as when most activities make symptoms worse. This is the time for splinting, reducing activities of daily living (which sometimes includes work restrictions), and the use of ice cupping or massage. Patients should initiate movement or exercise-based approaches as soon as such activities can be tolerated. Here are four different exercises you can do:
1. Fist / “Bear Claw” / Open Wide Hand: This is a three-step exercise, and you can start or stop on any of the three “steps.” A. FIST:  Make a fist and squeeze as tightly as tolerated; B. BEAR CLAW: Starting from the fist position (A), open only the palm of the hand (keep your thumb and fingers bent but straighten the big knuckle joints at the base of the fingers); C. OPEN WIDE: Straighten and spread ALL your finger joints by opening up your hand as much as possible and feel for a good stretch in the palm. HOLD each position for one to five seconds (vary the “speed” of moving between the three positions – fast, medium, and slow; emphasize what feels best if you have a preference). Repeat five to ten times or until your hands feel looser.
2. “Church Steeple”: Place your hands together in front of you (“prayer position”) touching the pads of the thumbs and all four fingertips together and spread your fingers as wide as possible. Next, separate your palms as far as you can while applying pressure against your finger/thumb tips and repeat. Alter the speed and number of repetitions until your hands feel stretched out.
3. “Shake and Flick”: Simply shake your hands as if you just washed them and you’re shaking the water off to “air dry” them. Again, alter the speed and reps until they feel loosened up.
4. Forearm Stretches: Place one arm out in front, elbow straight, and fingers pointed straight, palm up (first set). Reach with the opposite hand and pull the fingers, hand, and wrist down and back towards you until you feel a strong “pull” in your forearm muscles. Hold until the forearm muscles feels stretched (5-10 seconds). Repeat this with the palm facing down for the second set to stretch the opposite (extensor) forearm muscles.
Do these on each side two to three times each (even the “good” side) EVERY HOUR (or as often as possible). Think about what you do on a daily basis and if you work in a repetitive manner (on the job or a hobby at home), try to do these exercises DURING THE REPETITIVE ACTIVITY to help keep your symptoms from getting out of control. If you can alter the position or speed of a work or avocational activity, do so for long-term prevention purposes!
If you cannot gain control of your CTS condition, you may need additional treatment options of which chiropractic offers a safe, non-surgical approach.
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 Carpal Tunnel Syndrome, we would be honored to render our services.

10 Quick Back Pain Tips

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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!

Chiropractic As Opioid Alternative

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Opioid therapy

Chiropractic is an important part of the solution of the opioid crisis going on worldwide. This is an interesting article outlining how Chiropractic can be a part of the pain team for any number of conditions that previously have been handled with opioid drugs.

https://www.prnewswire.com/news-releases/chiropractic-the-proven-alternative-to-opiates-and-surgery-for-pain-300531305.html