Chiropractic Is A Good Solution For Low Back Pain
In case you haven’t noticed, there’s a lot of discussion in healthcare circles regarding usage of pain medications and especially opioids.
The Wall Street Journal summarized a study by the American College of Physicians regarding treatment of low back pain:
According to new guidelines developed by the American College of Physicians,39 conservative non-drug treatments should be favored over drugs for most back pain. The guidelines are an update that include a review of more than 150 recent studies and conclude that, “For acute and subacute pain, the guidelines recommend nondrug therapies first, such as applying heat, massage, acupuncture, or spinal manipulation, which is often done by a chiropractor.” — The Wall Street Journal
Monique Trello, M.D., MPH, contributing editor to the Harvard Health Blog from Harvard Health Publications, went on to remark that, “Because some medications carry significant risks, we really shouldn’t be recommending these right off the bat. Rather, we should be providing guidance on heating pad or hot water bottle use, and recommendations or referrals to acupuncturists, massage therapists, and chiropractors. These therapies were somewhat effective, and are very unlikely to cause harm.”
Naturally, every patient’s condition and body is unique. However, in general starting off conservatively and then moving into more invasive treatment if the conservative treatment fails, much like going up a series of steps, provides the greatest benefit to the patient with the least risk. Fortunately, that’s the model we have been using for several years. If we can help someone with conservative treatment, we try to do so. If it works out, then great. If not, then we send them to the ‘next step’ to someone who will be able to help them get out of pain and enjoy life.
“Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” published at Annals.org on 14 February 2017.
Monique Tello POSTED APRIL 12TH, 2017 http://www.health.harvard.edu/blog/low-back-pain-try-steps-first-201
Wall Street Journal No Drugs for Back Pain, New Guidelines Say: The American College of Physicians says to use natural and alternative therapies first. Sumathi Reddy Feb. 13, 2017 www.wsj.com
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Learning the risk factors of sciatica can help you minimize your risk of developing it. A recent study sheds light onto what makes you more likely to develop sciatica.
The study evaluated 5261 participants aged 40-60. Researchers collected data on participants’ occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure-time physical activity, and history of neck and back pain.
Risk factors for sciatica varied based on gender. Women were more likely to have sciatica if they worked in manual occupational class, were overweight, smoked, lived a sedentary lifestyle, and had previous neck and back pain. Among men participants, those employed in semi-professional and manual occupational classes had higher risk levels. Researchers concluded that occupational class, unhealthy lifestyle and a personal history of back and neck pain made patients more likely to develop sciatica.
Chiropractors have been successfully treating sciatica patients for years. Talk to a chiropractor about assessing your risk factors for sciatica and/or receiving effective treatment.
Kaaria S, Leino-Arjas P, Rahkonen O, Lahti J, Lahelma E, Laaksonen M. Risk factors of sciatic pain: A prospective study among middle-aged employees. European Journal of Pain. 2010 Dec 14.
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Chiropractic Treatment of Sciatica
Written by Ron Grassi, DC MS ACFEI
Doctors of Chiropractic (DC) medicine regularly treat sciatica. Sciatica is characterized by pain that originates in the low back or buttock that travels into one or both legs. Sciatic nerve pain varies in intensity and frequency; minimal, moderate, severe and occasional, intermittent, frequent or constant.
Pain is described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks. Other symptoms associated with sciatica include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder—however, sciatica is really a symptom of a disorder.
Sciatica Is Caused by Nerve Compression
Sciatica is generally caused by sciatic nerve compression. Disorders known to cause sciatic nerve pain include lumbar spine subluxations (misaligned vertebral body/ies), herniated or bulging discs (slipped discs), pregnancy and childbirth, tumors, and non-spinal disorders such as diabetes, constipation, or sitting on one's back pocket wallet.
One common cause of sciatica is piriformis syndrome. Piriformis syndrome is named after the piriformis muscle. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis, or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby pinching the sciatic nerve and causing inflammation and pain.
Sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.
Proper Diagnosis of Sciatica Is Essential
Since there are many disorders that cause sciatica, the chiropractor's first step is to determine what is causing the patient's sciatica. Forming a diagnosis involves a thoughtful review the patient's medical history, and a physical and neurological examination.
Diagnostic testing includes an x-ray, MRI, CT scan and/or electrodiagnostic tests (nerve conduction velocity, electromyography). These examinations and tests help to detect possible contraindications to spinal adjustments and other chiropractic therapies.
Chiropractic Treatment of Sciatic Symptoms
The purpose of chiropractic treatment is to help the body's potential to heal itself. It is based on the scientific principle that restricted spinal movement leads to pain and reduced function and performance. Chiropractic care is non-invasive (non-surgical) and drug-free.
The type of chiropractic therapy provided depends on the cause of the patient's sciatica. A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments (sometimes called spinal manipulation). Below are more details on these chiropractic treatment modalities.
- Ice/Cold therapy reduces inflammation and helps to control sciatic pain.
- Ultrasound is gentle heat created by sound waves that penetrates deep into tissues. Ultrasound increases circulation and helps to reduce muscle spasms, cramping, swelling, stiffness, and pain.
- TENS unit (transcutaneous electrical nerve stimulation) is a small box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms. Larger versions of the home-use TENS units are used by chiropractors, physical therapists and other rehab professionals.
- Adjustments (Spinal Manipulation) At the core of chiropractic care are spinal adjustments. Manipulation frees restricted movement of the spine and helps to restore misaligned vertebral bodies to their proper position in the spinal column. Spinal adjustment helps to reduce nerve irritability responsible for causing inflammation, muscle spasm, pain, and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is proven to be safe and effective.
In college and during their training, students of chiropractic learn many different adjustment techniques enabling them to treat several types of subluxations and disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision. Spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.
Chiropractic's Limitations in Treating Sciatica
Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If the doctor of chiropractic determines the patient's disorder requires treatment by another type of doctor, then the patient is referred to another specialty. In some cases, the referring chiropractor may continue to treat the patient and co-manage the patient's care with the other specialist.
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Preventing Migraines with Chiropractic (video)
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How To Use Ice and Heat
Ice or Heat? This video answers a common question about when and how to use ice and heat at home. I hope this is helpful to you.
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4 Diets I've Tried
I struggle with weight control. There, it’s out. Since I was a kid controlling my weight has always been an issue. My problem is not with exercising; I have always done that routinely. My problem lies with overeating. So, rather than approach dieting from a ‘scientific’ approach, I thought it best to share a couple of methods I have tried to control eating, giving the pros and cons. If something strikes you as helpful, then I hope you are able to put it into practice.
One important concept to remember regarding weight control, is that your body basically works on an energy equation. Food equals energy in; using muscles equals energy out. Therefore:
energy in > energy out → gain weight
energy in < energy out → lose weight
energy in = energy out → maintain
So, in it’s simplest form, diets help you address the ‘energy in’ component of the equation and exercise addresses the ‘energy out.’ OK, the math part is over. Here’s what I’ve tried:
Adkins. This diet is based on the premise that limiting energy-rich carbs forces your body to burn up its energy stored in fat. Therefore, you can eat as much as you want of certain types of foods, but not others (eg. eat meats, but no bread and limited fruits).
I did well with this for a while and felt better as I lost weight. However, after several weeks I found it difficult to maintain the strict guidelines. Apparently I am not alone as most others tell me the same thing: it worked while they were on it, but it was hard to do it consistently, so they stopped doing it.
Weight Watchers. The idea here is two-fold:
Limit the amount of food you are eating by attributing points to food, and allowing yourself a set number of points per day, and
Join with others who are travelling the same path as you for encouragement.
Of all the methods I have tried, I probably liked this one the best. It was surprising how much food I actually ate until I stopped to measure it. Plus, it’s surprising how full only a small amount of food could make me feel. Having others along the ride for encouragement is certainly a plus when it’s a struggle to keep going. There is some cost to be a part of the group, and although they have dessert substitutes you can try, I didn’t find them very tasty.
Because Weight Watchers encourages you to make healthy choices, without limiting what food you can actually eat it's easier to stay with the program. I did well initially. However, after a while I fell into the temptation to keep up with the food points in my head, rather than stop and write them down. Over time I worried less about the points and drifted back to larger portion sizes. Next thing I knew, I was ‘off the wagon.’
My Fitness Pal. This works along the same lines as Weight Watchers in that you limit the amount of food you take in. In this case, however, you're counting calories instead if points. It works off a smartphone or tablet app, which is very convenient to use. The cost is free, which is a plus. You can have friends join your group, but there are no meetings to help keep you focused if your attention wanes.
Again, I did well for a while, but grew tired of listing my food and trying to find out exactly what I was eating--especially if it was not something straightforward, like a casserole. Much like Weight Watchers, I tried to keep up with it in my head and soon dropped it altogether.
Weigh Down. This was a unique diet I did several years ago. The same idea applies in that you limit your food intake. However, instead of counting calories or points, you go by how you feel. Not by how your brain feels, but by how your stomach feels. Basically, when you're hungry, you eat, when you're full you stop.
For as simple as this sounds, it was actually a little difficult to get started since it took a little while to be honest with myself about how I really felt. The best sign for being hungry was to wait until my stomach growled. Once it growled, I ate (without overeating) until I was full. After eating I wouldn’t eat again until my stomach growled. Within a couple of weeks, I began to know what ‘being hungry’ felt like, without having to wait for my stomach to growl.
Foolishly, I intentionally got off this diet when I went on vacation, thinking I would quickly get back on it when I was done. Unfortunately didn’t have the discipline to go through the first steps again and the weight came back.
This sums up my dieting trends. Since the term ‘diet’ conjures up a feeling of ‘temporary restriction of good food’ I am making myself think in terms of ‘eating habits.’ Since I do need to lose weight (again) I want to make changes that are both enjoyable and sustainable. That’s really the focus of methods 2-4, I just didn’t do them long enough for the good habits to be ingrained.
I hope this was helpful. If you’re planning on changing your eating habits as well, feel free to try any of these methods to give you some disciple in getting the process started. Then, keep it up. The only difference between losing 5 lbs and losing 50 lbs is time.
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Maintenance is a normal part of our everyday lives.
Your dentist doesn't expect to see you once and then never again. Orthodontists highly recommend retainers for several years after using braces. Even a brand-new car has a thick book telling you how maintain it at regular intervals.
A study in the Journal of Manipulative and Physiological Therapeutics (JMPT) in 2004 and Spine in 2011 showed that maintenance spinal treatment sustained the benefits of the initial treatment, and that the pain, or the limitations to lifestyle caused by the pain, would often return if the progress was not maintained.
In other words, maintenance treatment had a long-term benefit.
How does maintenance work?
At the end of your active treatment plan, you’re released from care.
At this point, your spine is moving well.
In time the joint will tighten up. If this takes years, then maintenance is not for you. If it takes weeks or months, then it is.
You schedule to return in a few weeks.
We add time between visits to reach our goal of being treated after the joint tightens up, but before it hurts.
Everyone needs maintenance care: Not necessarily. Everyone is different; some will benefit more than others.
It has to be once per month: No, the time varies depending on the patient’s spinal condition and the stresses on their spine from work or play.
Insurance should pay for maintenance: No, insurance helps to dig you out of a ditch, not keep you out.
If I start going, I’ll have to keep going forever: Yes, forever and ever. JUST KIDDING. The goal is to be able to maintain an active lifestyle without pain. If you can do that without maintenance treatment, that’s great. If not, we are here.
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¨ Pain – the severity and location of the pain depend upon which disc is herniated and how large the herniation is.
¨ Pain may spread over the buttocks, down the back of one thigh and into the calf
¨ Pain may be in one or both legs
¨ Numbness, tingling, or weakness in the legs or feet
¨ In severe cases, inability to find comfort even lying down
¨ Inability to fully straighten your neck or back
¨ Numbness, tingling, or weakness in one or both arms
Spinal discs are placed between the bones or vertebrae of your spine to act as a spacer and shock absorber. These discs are soft and spongy in the center, but tougher on the outside. They help keep the spine flexible.
At times, whether from an injury or just wear and tear, the soft material in the middle of a disc pushes to one side and may push through the sides. This is called a bulging or herniated disc. Predominately this occurs in the lower back, but may also occur in the neck. It is less frequent in the mid-back. If it presses against a nerve, the pain will radiate into the leg or arm.
This condition is often very painful and life-altering, making even normal activities difficult to do. Treatment ranges from rest and pain medications to spinal surgery, but usually begins with conservative treatment that becomes more invasive if the patient does not respond well to care. Chiropractic treatment, therapy and exercises are a good starting place, yet the old adage holds true that prevention is the best cure.
What can you do to prevent problems? First, pay attention to good biomechanics. Keep your back straight when lifting, sitting or standing. Don’t sit for over 20-25 minutes without taking a break. Have a consistent exercise program. Lastly work on core exercises to help strengthen important abdominal and back muscles which help to reduce stress on the disc.
If you suspect you are having a problem, call our office.
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A 1999 Australian study published in the journal Spine demonstrated a change in posture with backpack use. This is especially important in the adolescent age group with growing and changing spinal structures. Various studies have demonstrated an increase in headaches and even arthritis from alterations in the normal spinal curves. In other words, changes during the current developmental period could lead to future health problems in late adolescence or adulthood.
Lands' End Direct Merchants surveyed and discovered that 96% of 8-12 year olds will carry a backpack to school. Of these, one-third will carry it improperly.
According to the American Chiropractic Association’s Council on Occupational Health, a recent Italian study determined that the average child carries a backpack weighing the equivalent of a 39-pound backpack for a 176-pound man, or a 29-pound backpack for a 132 pound woman.
What can be done to prevent children from developing painful problems later in life? Try applying the following tips:
- Make sure the backpack weighs no more that 5-10% of the child’s body weight to prevent excessive forward bending. Contrast this with what has been found to be normal:
- Backpacks for fourth graders were found to be14.7% of their body weight, while
- Fifth grader’s backpacks averaged 17.1% of their body weight.
- 23% of the children (4th and 5th graders) carried a backpack weighing more than 20% of their body weight
- Position the backpack so that it doesn't hang more than 4 inches below the belt line.
- Make sure the backpack is well-designed for their body and the shoulder straps are adjustable
- Wear both straps. This is so important! Lugging the pack with one shoulder may lead to neck and muscle spasms and low-back pain.
- If the pack is too heavy, talk to the teacher about only bringing home workbooks or consider a pack on wheels
- Bigger is not always better; more space = more load
- If these changes do not help, consider an alternative—backpacks on wheels
Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features.
Spine 1999 Nov 1;24(21):2262-2267
Lynn J White, Heidi E Frasure and Patrick White Weight of Backpacks Carried by School Children: Students or Sherpas? Acad Emerg Med 2000 Oct;7(10):1168
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5 Back to School Tips To Keep Your Kid’s Back Healthy
Follow These 5 Back to School Tips to Keep Your Kid’s Back Healthy
If your like me you are preparing your kids to head back to school. As an ergonomist, a person who evaluates people interacting with their environment, I am looking for ways to reduce the physical stress on their bodies. Here are 5 tips on getting your child ready for school:
- Books – If your child has many books they need for school, consider buying 2 sets. One for school and one for home. If this is not possible, remove books and school equipment that is not necessary for your child on that day.
- Home Study Area – Make sure your child’s desk/study area is clutter free and set up for ‘their’ height, not yours.
- Check Eyesight – Poor eyesight can lead to poor postures and poor performance. Make sure your kids are set up for success by making sure their vision is 20/20.
- Shoes – Some people buy clothing for their child to grow into. Shoes should not be one of them. Make sure their shoes are in good condition and properly fitting. Foot and ankle issues can lead to greater problems as they age.
- Computer – Make sure the computer is set up properly for your child. Please check out our Desktop or Laptop Setup Guide.
by Petersen Physical Therapy on August 8, 2014 in Petersen Carling News, Uncategorized
by John Naumann
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