Tuesday, June 1, 2010

Why does my back alway hurt?

Low back pain is a very common problem affecting 80-90% of all of us at some point in our lifetime. Why is that you ask? There are many reasons. One of the biggest reasons is that we are 2-legged animals carrying 2/3rds of our weight above our waist. Studies have shown deterioration or arthritis occurs much sooner in us vs. our 4-legged animal counterparts. A 180 lbs man carries roughly 120 lbs above the waist. This means, every time he bends over, in order to stand upright, he needs to lift 120 lbs PLUS whatever he is lifting. Hence, the argument of, “…but I only bent over to lift a pencil and my back went out,” seems on the surface as impossible but in reality, the man in our example is lifting the pencil plus 120 lbs. Now, let’s add to that the point that a 5 pound weight equals 50 pounds when held out in front with the arms stretched out straight. Now, if that’s not bad enough, now, let’s assume all of this is happening from a bent forward position, with a twist at the waist, with out stretched arms, while lifting a 20 pound object. Get the idea? It’s amazing our back doesn’t get injured every day as we lift 2 bags of groceries into the far end of a car trunk, or, when lifting our 30 pound child in and out of a car seat, height chair, or when they are screaming and pushing away from us as we try to lift them!

In order to further appreciate why the low back is so vulnerable to injury, some basic understanding of anatomy is needed. When we’re born, the back is made up of 33 segments of which 5 fuse by the time we’re about 18 years old to make up the sacrum (bottom of the spine) and 4 fuse to make up the coccyx (tail bone), leaving 5 lumbar (low back), 12 thoracic (mid-back) and 7 cervical (neck) vertebra. These are stacked up on top of each other like building blocks and are connected to each other by a shock absorbing disk in the front and two smaller facet joints in the back, acting like a tripod. In the low back, we’re supposed to bear about 80% of our weight in the front and 20% in the back but, if our abdominal muscles are a bit out of shape and the pelvis rotates forwards, the curve in the low back increases and overloads the back of the vertebra (facets) making them vulnerable to injury. The disk becomes injured when we bend/lift/twist. This can tear the outer tough fibers of the disk, allowing the central more liquid-like material to leak out. If this happens, the leaking or “herniated” disk can put pressure on the nerve that exits the spine and travels down our leg. If the pain pattern includes the back of the leg, it’s commonly referred to as “sciatica.”

OK, enough about anatomy. What can we do to reduce the chances of having periodic low back pain? Obviously, staying in shape is very important. Certain muscles of the body must be tight to keep us upright or standing. These muscles need to be stretched on a regular basis. For example: the hamstring muscle. We’ve all had to perform hurdler types of exercises and remember how tight they feel!

We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for low back pain, 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.

Fibromyalgia and Chiropractic

Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.

Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?

The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.

Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, 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.

Whiplash and Chiropractic

Whiplash occurs when the neck is suddenly and forcefully jerked, and is typically associated with car crashes. The speed at which the neck is forced upon impact is faster than we can contract our muscles in attempt to stop the forceful movement. This results in muscle, tendon, and/or ligament over-stretching, even tearing. Symptoms include stiff and painful neck movements, weakness or, the head “feels heavy” making it challenging to “hold up” as well as headache, and sometimes dizziness, ear noises, TMJ or jaw pain, and “mental fog.” What should be done if a whiplash injury occurs?

The amount or degree of damage to the soft tissues - that is, the muscles, tendons, ligaments, and disks of the neck — will be the deciding factors as to how much rest vs. activity should be initially performed. If there are no fractures, dislocations or other injuries resulting in an unstable cervical spine (neck), studies have shown rest and a soft collar is actually harmful when compared to early return to activity and exercises. Chiropractic treatment, which essentially exercises the joints of the neck, has been shown to speed recovery when performed sooner rather than later after a whiplash injury. A handy way to classify the injury includes four categories: 1) Pain with no significant abnormal clinical findings; 2) Pain with mild clinical findings and range of motion loss; 3) Pain with neurological injury (resulting in radiating arm pain); and 4) Pain associated with fracture and/or dislocation. Those suffering with category 1 or 2 injuries should minimize rest, collar use, proceed with life’s activities and not be afraid to do desired activities. More aggressive exercise and, utilizing chiropractic adjustments as soon as possible is very effective in the first two categories of injury. Category 4 (fractures and dislocations) injuries require the use of a rigid collar usually for 4-6 weeks as rest/protection is imperative. Category 3 demands careful monitoring by your chiropractor as neurological problems like arm pain and numbness, muscle strength weakness, must be watched during the healing process. The use of ice is helpful with all four categories of injury and exercise training is important and can be started sooner in the first two categories of injury.

What can you do if you sustain a whiplash injury? The first order of self-help is the use of ice. This is a much better choice over the use of heat as ice reduces swelling and pain while heat can increase swelling because it brings in more blood flow into an already swollen area. The heat may feel good during its use but most patients report the pain either returns shortly thereafter or feels worse. Ice and heat can be alternated but ice should be emphasized by using ice for 10 minutes, heat 5 minutes, and repeat the ice / heat / ice approach starting and ending with ice. One session usually equals 40 minutes (ice/heat/ice/heat/ice for 10+5+10+5+10, respectively, = 40 min.), and several sessions can be repeated each day. The old adage of “ice for 24 hours followed by heat” does NOT apply here as ice or “contrast therapy” of ice/heat/ice/heat/ice can be performed for as long as there is pain or, for several weeks or longer. The good news is that you will never hurt yourself by using ice but, you can make it hurt worse by using heat too soon so, when in doubt, use ice! The next, very important, recommendation is to utilize exercises to stretch and strengthen the neck and upper back region. The “general rule” of exercise is slow repetitions staying within “reasonable” boundaries of pain. That is, a good, stretch type of pain is encouraged while avoiding sharp pain. We have discussed several very practical neck stretches and strengthening exercises previously and we will again address this in the future. Posture correction of chin tucks, keeping your head back over your shoulders is very helpful as well. We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.

Carpal Tunnel Syndrome & Chiropractic

“When I try to thread a needle, button my shirt, or crochet, I can’t seem to feel my finger tips. I’ve also noticed when unscrewing jars, my grip feels weak. In fact, I almost dropped a cup of coffee the other day. I wake up 3-4 times a night and I have to shake my hand and flick my fingers to wake them up. Gripping the steering wheel is becoming a challenge and I have to change hands frequently while I drive. I’ve had this off and on for the last 5 years but this last year it seems to be getting worse. I’m really getting concerned. Can you help me?”

If this history sounds familiar, you may be suffering from carpal tunnel syndrome or CTS. It’s a very common disorder affecting millions each year. Its also one of the biggest problems for certain types of industries such as meat packaging plants, textile manufacturers, and virtually any job that requires fast, repetitive movements commonly used on assembly lines in many lines of work.

CTS is the result of pinching of the Median Nerve as it travels from the neck into the arm, through muscles in the forearm and into the hand through the carpal tunnel. Pressure on the nerve at any of these locations can create the symptoms of CTS. This tunnel is quite small in size and included inside the tunnel are 9 tendons, blood vessels, and the median nerve. When the muscles of the forearms and hands are overworked, they inflame and swell. Because the carpal tunnel is normally so tight, the increased swelling inside the tunnel pushes and pinches the median nerve creating the classic pain, numbness, tingling, and sometimes burning sensations often described by people suffering with CTS.

Certain situations make people more vulnerable or prone to develop CTS. CTS is more common in woman than men by 3 or 4:1. This is partially because women’s bone structure is smaller and therefore their Carpal Tunnel is smaller too.

Women also experience fluid retention or build up during menstruation leading to symptoms like swollen fingers and swollen and painful breasts. Swelling in the already tight, confined space of the carpal tunnel will increase their susceptibility for developing CTS. Another hormone related cause or contributing factor is the use of birth control pills (BCPs). Since there are many different types of BCPs and each woman is unique and different, finding the BCP with the “right balance” of hormones where the swelling side effect is minimized is very important and should be discussed with the doctor who prescribed the BCPs.

Age (>50 years) is also a risk factor and with our aging work force, this is becoming a big issue. Other conditions like hypothyroid, diabetes, certain types of arthritis, and hypertension / congestive heart failure where an increase in fluid retention occurs can also increase the chance of developing CTS. Obviously, occupation type plays an important role as previously mentioned. Many jobs today require the use of computers and we’re finding the position of the monitor, the keyboard and mouse, are very important.

Chiropractic management of CTS includes wrist, forearm/elbow, shoulder and neck adjustments, corrective exercises, the use of night splints, and an anti-inflammatory diet. Also, correcting the “ergonomic factors” or, job-related causes is of utmost importance. This is why a chiropractor who treats all of these areas and has the specialized knowledge about CTS is the perfect choice of health care providers. If you, a friend or family member require care for CTS, we would be honored to render our services.