Health Update: Low Back Pain
Back School 101…
3 Ways To Prevent Making Your Back Pain Worse
Chiropractic care for patients with low back pain (LBP) not only includes spinal manipulation or adjustments but also patient education in regards to heat/ice, performing daily activities and exercise.
Heat vs. Ice: This topic is controversial, as often, patients will be told by their friends and family to use the opposite of what we may recommend to our patients. In general, when pain is present, there is inflammation… so use ice to reduce swelling and pain. When heat is inappropriately utilized during this inflammatory phase of healing, vasodilation or, an increase in blood supply to the already swollen injured area often results in an increase in pain. The use of heat may be safely applied later in the healing process during the reparative phase of healing, but as long as pain is present, using ice is usually safer and more effective.
Daily Activities: Improper methods of performing sitting, bending, pulling, pushing, and lifting can perpetuate the inflammatory phase, slow down the healing process, and interfere/prevent people from returning to their desired activities of daily living, especially work. Improperly performing these routine activities is similar to picking at scab, since you’re delaying the healing process and you can even make things worse for yourself.
Exercise: There are many exercises available for patients with low back pain. When deciding on the type of exercise, the position the patient feels best or, the least irritating is usually the direction to emphasize.
More specifically, for those who feel a reduction in pain when bending forward (referred to as "flexion-biased"), flexion exercises are usually indicated. Examples of these include raising a single knee to chest, double knee to chest, posterior pelvic tilts, sitting forward flexion, and hamstring stretches.
When bending backwards results in pain reduction (referred to as "extension-biased"), standing and bending backwards, performing a sagging type of pushup ("prone press-up"), laying backwards on large pillows or on a gym-ball are good exercises. The dosage or duration exercises must be determined individually and it is typically safer to start with 1 or 2 exercises and gradually increase the number as well as repetition and/or hold-times. If sharp/"bad" pain is noted, the patient is warned to discontinue that exercise and report this for further discussion with their chiropractor. It is normal and often a good sign when stretching/"good" pain is obtained at the end range of the exercise.
We recognized the importance of patient education in our approach to managing low back pain cases, and look forward in serving you and your family presently and, in the future.
Health Update: Low Back Pain
Low Back Pain – Seasonal Injuries
Every season brings unique activities that require us to perform some physical activity we may not want to do but have no choice. In the winter, shoveling snow comes to mind (at least in some parts of the country) while spring, summer and fall may include yard clean up, mowing, and raking. All of these seasonal activities are, “I have to...” activities of daily living, rather than activities we want to do. Therefore, let’s talk about shoveling snow since that time of year is upon some of us, though hopefully on its way out! Of course, if snow is not an issue based on where you live, this information can also be applied to gardening, digging a hole or some other yard-related shoveling activity.
First, a few facts that help us appreciate why back pain is so common when we shovel: 1. When we bend over, approximately 2/3rds of our body weight is being lifted in addition to what we’re lifting. Hence, a 180 lb. person has to lift 120 lbs. of body weight every time he or she bends over. 2. A 5 lb. weight equals 50 lbs. to our backs when it is held out in front of us – consider the 10-20 lb. weight on the end of a shovel! 3) Our legs are much stronger than our backs and arms. If a person can bench press 300 lbs., they can usually leg press 500 lbs. - almost 2x more weight. Yet, most of us use our arms, not our legs, when shoveling. 4) Most of us bend over using poor technique, lift the shovel with the arms and back (not the legs), and rapidly extend and twist the back when we throw the substance from the shovel – 3 bad things! 5) Then, this faulty action is repeated many, many times, and on top of that, it is not something we’re used to doing and hence, we’re not physically adapted or “in shape” for shoveling. With all of these “truths,” it’s no wonder why we often can barely move after an hour of shoveling! So what can we do about it?
I suppose hiring the neighborhood kid to do our shoveling makes the most sense but we’re not that smart! We can’t change the fact that most of our body’s weight lies above our waist so that one we’re stuck with and, we’re not going to lose weight in time for shoveling. But, we can certainly put less material on the shovel so the load on our back is less. It’s important to squat down using our strong leg muscles while keeping our back as vertical/straight as possible- DO NOT BEND OVER. Try sticking out your fanny (to keep an inward curve in your back), lift the shovel / load of material straight up with your legs, maintaining that arched back / butt out position. Keep your arms / elbows straight and walk the shovel load over to the dumping location – DON’T try and throw the load a distance by twisting your body. Take multiple breaks and switch sides so you don’t “beat up” the same muscle groups repeatedly.
If you do hurt your back - using an analogy of a cut on your skin –avoid picking at the cut so it can heal. If your back hurts after shoveling, use ice/rest followed by gentle stretching and modified activities – DON’T go back out and shovel (ie, don’t pick at your cut!). Some wise considerations for shoveling include warming up before starting, staying “in shape” by regular exercise throughout the year, maintaining a good nutritional diet and getting enough sleep.
If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600
Health Update: Low Back Pain
Chiropractic Care and the Elderly
Chiropractic treatment of low back pain has been reported to be very safe and highly effective. In fact, in 1994, guidelines were published recommending that chiropractic treatment of low back pain should be a first consideration / treatment of choice in front of many other forms of back care health services. Since that time, more and more studies have been published showing continued advantages of chiropractic care over many other forms of low back pain care.
Even though studies have shown that the peak prevalence of low back pain occurs in the 5th decade of life, low back pain is also a significant public health problem in older adults ranging between 13% and 49% with “…soaring costs in terms of health care expenditures.” So, what about care for the elderly – is chiropractic care equally safe and effective in this older population as it is in younger patients?
A recent study reported two types of spinal manipulation or adjustments versus minimal conservative medical care (MCMC) in patients with subacute or chronic, non-radiating low back pain over 55 years of age. This included a total of 240 participants, of which 105 were women and 135 were men with an average age of 63 years. The two types of manipulation included a high velocity low amplitude type (the classic “cracking” type of manipulation) and a low velocity variable amplitude type (stretch - not associated with a “crack”) treated 12 times over a 6 week time frame. A 3rd treatment group (MCMC) served as a “control” to compare against the two manipulation approaches. All three groups received a half hour exercise session at week 3 and outcomes were studied at 3, 6, 12 & 24 weeks. The results showed equally effective benefits to the two styles of manipulation over the MCMC group, with no serious adverse events associated with any of the treatment groups.
This study is important in a number of ways. First, it points out that two distinctive styles of manipulation frequently utilized in chiropractic and likely to be encountered by patients obtaining chiropractic care, are equally effective in a population exceeding 55 years of age. The type of manipulation ultimately decided upon can therefore be based on: 1) patient preference (as some patients just don’t like being “cracked”) and 2) the chiropractor’s clinical experience.
When visiting our clinic, we take pride in providing accurate, up-to-date information about our patient’s condition and what must be done to obtain long term, satisfying results. We appreciate the opportunity to provide care to our patients and strive to make the experience highly satisfying.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Health Update: Low Back Pain
The Many Faces of Low Back Pain
Have you experienced low back pain lately? There are many causes of low back pain which need to be properly and thoroughly evaluated. The obvious cause may be attributed to specific activity, especially one that has not been performed in quite some time. This may include a sports injury, gardening or yard work related injury, or, it may result from the accumulation of multiple smaller activities that you are not used to doing. Sometimes, the cause of low back pain can be obscure and difficult, if not impossible, to determine. In these cases, a thorough history is important. For example, Lyme’s disease can create the classic low back pain presentation and its diagnosis is dependent on a blood test. Don’t be fooled by the fact that the patient may not be an outdoors type of person, “…and couldn’t possibly have been in contact with a tic.” Many inactive patients have pets that can transfer the deer tic larva into a home and transfer it to a sedentary, non-active person. If the cause of low back pain is difficult to determine, Lyme’s disease may be worthy of investigation.
Another cause of low back pain can arise from certain medications. In a July 2010 journal article, muscle fiber damage was found in 57% of patients taking drugs associated with lowering cholesterol, referred to as statins. Typically, health care providers rely on a blood test that is suppose to detect the breakdown of muscle tissue called CPK (creatine phosphokinase) when statin-related muscle damage is suspect. However, in their study, only one in 44 patients with muscle damage caused by statin drugs was abnormal! The American College of Cardiology and the American Heart Association have published guidelines recommending continuing statin therapy, “…as long as circulating levels of CPK do not exceed 10 times the upper limit of normal (1,950U/L).” To see if that was a good recommendation, CPK was tested in 10 healthy volunteers who had never taken statins, 10 control subjects matched by age, 15 patients with clinically diagnosed myopathy from statins but had stopped the statin therapy at least 5 weeks prior to the study, 29 patients with a history of statin-associated myopathy who remained on statin therapy and 19 patients with long-term statin therapy but no muscle complaints. Significant muscle damage (>2% of the biopsied muscle sample) was NOT seen in any of the control patients not taking statins. However, it was seen in 1 of the 19 patients on long-term statin therapy who reported no muscle symptoms as well as 25 of the 44 with myopathy (57%). More importantly, all but 3 patients who quit statin therapy because of related muscle pain reported their symptoms disappeared within days of quitting the statin medication. Also, the rate of significant muscle damage was about equal in those with myopathy still taking the statin meds (55%), and those who had quit the medication (60%). The severity of muscle damage was not related to the length of time the statin med was used or, with higher doses of statins.
The point of this discussion is that low back pain may be related to causes other than an injury or trauma to the back. If you, a friend or a loved one suffers from low back pain, treatment with the Pro-Adjuster or the DRX 9000 non-surgical disc decompression therapy may help relieve your low back pain.
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 low back pain episodes.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Low Back Pain and the Hamstrings
Have you ever considered how important your hamstring muscles are in relationship to your low back? Most people do not think about those tight muscles on the back of the upper leg or thigh as having much to do with low back pain. However, it is one of the most important muscle groups to keep loose both as a means of improving current low back trouble as well as preventing future low back pain. 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 forward 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 back injury, as well as perpetuating a current problem. The best way to 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.
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. 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 low back pain episodes.
What Makes Low Back Pain So Common?
Low back pain is one of the most common types of pain involving the musculoskeletal system. Low Back Pain sufferers may sometimes miss work or be unable to participate in desired activities, social outings, and the like. It can be so disabling that out of desperation, they visit the emergency room.
There are many causes of Low Back Pain. 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 Low Back Pain seems to occur for no apparent reason, or at least none that can be clearly identified. One of the most basic causes of Low Back Pain 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 Low Back Pain 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 Low Back Pain.
Because many of these characteristics are not properly attended to, Low Back Pain 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 Low Back Pain 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 Low Back Pain 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 Low Back Pain 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 Low Back Pain 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.
Low Back Pain and the Hamstrings
Have you ever considered how important your hamstring muscles are in relationship to your low back? Most people do not think about those tight muscles on the back of the upper leg or thigh as having much to do with low back pain. However, it is one of the most important muscle groups to keep loose both as a means of improving current low back trouble as well as preventing future low back pain. 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 forward 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 back injury, as well as perpetuating a current problem. The best way to 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.
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. 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 low back pain episodes.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
