Health Update: Low Back Pain

What Causes Low Back Pain?

I can’t tell you how many times a day this question is asked! Obviously, there are MANY causes of low back pain (LBP) but you may be surprised about some of the following:

1. Trauma: Let’s start with the easy one – falling down, over lifting, twisting, pushing, pulling, bending over, sporting activities, work activities, sex, sneezing, raking, shoveling……OK, I could fill the page with possible injuries that can cause LBP so I’ll stop here. We’ve all sprained an ankle or a finger and based on statistics, most of us have also suffered from LBP as a result of a single event injury. These types of injuries include sprains (ligament injuries), strains (muscle/tendon injuries), disk injuries (tears, ruptures), and include many possible findings including subluxations (areas where vertebrae stop working well together or have shifted from their proper location). When there is radiating leg pain that travels below the knee, a pinched nerve may be involved, often caused by disk pressure or a combination of things.

2. Insidious or, “I don’t know what I did!”: Believe it or not, this is probably the most common cause of LBP we see as the majority of people can’t recall anything as causing their LBP. The “cause” in these cases often stems from a series of events that accumulate to a point where pain/swelling occurs, often hours or even days after several over-use activities may have been performed. Thus, more investigation into the activities that preceded the onset of LBP needs to be considered. We can usually uncover several possible culprits but we can’t ever be 100% certain that we’re right about the cause(s). In some cases, people will wake up with LBP, while others don’t have it until they’ve been active.

3. Biomechanical causes: This category might be involved in the 2nd category discussed but deserves a separate discussion because of the many possibilities. First, we are 2 legged / not 4 legged animals and that by itself puts a lot of pressure on our lower backs. In fact, 2/3rds of our weight is carried from the waist up and as a result, just bending over for a pencil can, “…throw the back out.” For example, a 180# person lifts about 120# of body weight just by bending forward! Another common problem is one leg being shorter than the other. It has been reported that 87% of us have unequal leg lengths and when the shift measures 7-9mm (about ¼ inch), the probability of back, hip, or sciatica pain is 2x greater. When the difference is 16mm, there is an 8x greater chance of having back trouble. The “fix” in this case can be quite simple as using heel lifts in the short leg shoe. Flat feet and ankle pronation can also create an unstable pelvis and can contribute to LBP so foot orthotics can also be very helpful in the management of LBP. Obesity (body mass index >30) has been identified as a risk factor for a lot of conditions including LBP and a weight management program can be highly effective.

4. Dangerous loading activities: It has long been known that jobs where 50-100# is lifted or carried, especially if frequently handled, have an increase in occurrence of LBP. Using proper lifting methods is very important in jobs like this!

Weekly Health Update

Courtesy of:
Advanced Wellness
www.newjerseypainmanagement.net
www.advanced-wellness.net
(732) 719-8148

Mental Attitude: Social Class And Depression Treatment.  Current treatments for depression don't help working-class and poor patients as much as they help middle-class patients improve their ability to function at work. Depression has a profound impact on an individual's productivity. That's particularly true for those in lower social classes and with low levels of education.
Psychiatric Services, Nov 2010

Health Alert: Kicking It All!  The American Cancer Society's annual Great American Smokeout took place on November 18. Cigarette sales have declined for decades, but smokeless tobacco sales have grown 7% annually over the last four years. Using smokeless tobacco products is not a safe way to quit or safer than smoking. The use of these products just shifts the risk of cancer to the mouth, head, and neck. Use of cigarettes and smokeless tobacco is the leading cause of cancers of the head and neck, which can result in partial or full removal of the lip, tongue, cheek, and portions of the throat, including the voice box. Smokeless tobacco users run the same risks of heart disease, high blood pressure, and addiction as cigarette users, but an even greater risk of oral cancer.
American Academy of Otolaryngology - Head and Neck Surgery, November 2010

Diet: Red Meat And Cancer Risk.  A possible link between red meat and esophageal cancer; and a link between DiMelQx and cancer in the stomach close to the esophageal opening was found. DiMelQx is a compound, a type of heterocyclic amine (HCA) found in red meat after it is cooked at high temperature. Those who eat red and processed meats have a 79% higher risk of developing esophageal cancer.
American Journal of Gastroenterology, October 2010

Exercise: Flat Abs?  Here are a few exercises and tips to help flatten your abs. Improve Your Posture. Slouch and your stomach pooches. For better posture while standing, align your ears over your shoulders, shoulders over hips, hips over knees, and knees over ankles. Keep the fronts of the shoulders open like a shirt on a hanger, instead of a shirt on a peg and draw your navel to your spine. Try the Canoe Twist. Sit upright, interlace your fingers over your stomach to create a solid grip. Exhale, and sweep the interlocked hands, arms, shoulders, and chest to the left, as if "rowing a canoe." Inhale and return to the starting position. Exhale and perform the movement to the right. Alternate for 20 repetitions.
WebMD Feature: Tips for Flat Abs

Chiropractic: Happy Backs!  This is a satisfaction survey of chiropractic care within a military hospital, from a Canadian Armed Forces Pilot Project. Chronic low back pain accounted for most presentations to the chiropractic clinic. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services.
Military Medicine, June 2006

Wellness/Prevention: Tea And Your Heart. Drinking three cups of tea per day was associated with a decrease of 11% in the incidence of myocardial infarction, or heart attack.
American Journal of Epidemiology, 2001

"I can accept failure, but I can't accept not trying."

~ Michael Jordan

Health Update: Fibromyalgia

Fibromyalgia: How Do I know I Have It?

“I wake up every morning with this stiff, sore lower back pain. When I roll over to get out of bed, I feel like a log and almost have to fall out of bed. When I finally get to my feet, I’m all bent over and can’t stand upright for what seems like forever! It takes a couple of hours before it gradually loosens up enough so I don’t have to shuffle with each step. I was told by a friend that I might have something called fibromyalgia and should ask my chiropractor. What do you think?”

To answer this inquiry, let’s first define fibromyalgia (FM) so that we can compare the two properly. FM is a condition that is diagnosed basically by eliminating all other possible causes, including inflammatory joint conditions, by running various blood tests such as an arthritic profile. This usually includes tests for rheumatoid arthritis, gout, lupus, and infection. A Lymes disease test is often included as that condition can often manifest as a chronic back condition from any cause. There are essentially no blood tests, x-ray or other imaging tests, or neurological tests that can specifically diagnose FM. It is when all these tests come back negative, that the diagnosis of FM is then entertained. The history is probably the most important aspect of the clinical encounter that helps in the diagnosis of FM. Most of these patients will report that the onset is gradual, often present for years. There is usually no specific cause though there are specific conditions (such as irritable bowel syndrome, trauma, rheumatoid arthritis and others) that can result in “secondary fibromyalgia” where the cause is well known. The big differentiating historical feature is the presence of widespread, whole body pain – NOT just low back pain, as reported in the first paragraph above. In FM, there is often pain in the legs, arms, torso, back, neck and these people basically, “…hurt all over.” Typically there is no radiating pain down the leg or arm that follows a specific nerve pathway and no exam findings of neurological deficits. Another unique feature of FM includes sleep dysfunction. In many cases, sleep interruptions occur 2, 3 or more times a night, often with difficulty in returning back to sleep. The quality of pain is often described as numbness, tingling, burning, achy, deep, boring, and most importantly generalized in location (all over the body). The intensity is usually reported as high (>6/10 pain scale scores). The past history usually includes multiple visits to many different types of doctors and many attempts at different medications is common – most of which do not help significantly.

Even with these unique historical features that are consistent with the diagnosis of FM, it is still necessary to “rule out” other conditions by running tests as previously described. This is especially important when FM is secondary to other conditions as FM can get “lost” in the shuffle, overshadowed by the other condition.

Treatment for FM includes many of the same methods for treating other musculoskeletal conditions. Spinal manipulation, soft tissue release techniques (massage therapy, trigger point therapy, myofascial release), and various forms of physical therapy (low level laser therapy – LLLT, ultrasound, interferential electrical current – IFC, and pulsed magnetic therapy can also improve function, reduce pain, and reduce the need for medications. Cognitive therapy, addressing psychosocial issues, can also be very effective. One of the most important treatment approaches is exercise. This has been consistently described as being an important form of care for the FM patient. In addition, dietary management using an anti-inflammatory diet (gluten free diet) and supplementation (a multiple vitamin, calcium/magnesium, omega 3 fatty acids, Vit. D, and CoQ10) can also be very effective.

We recognize the importance of including chiropractic in your treatment 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.

Health Update: Low Back Pain

Low Back Pain
and Bone Density

So, what does bone density have to do with low back pain? The relationship between bone density and back pain is quite intimate. In fact, when the degree of bone density declines to the point of fracture, back pain becomes very real. The classic condition and cause of spinal pain associated with the loss of bone density is compression fracture.

Compression fractures occur when the strength of the bone decreases to a point where minor trauma and sometimes, no trauma whatsoever can result in fracture. Compression fractures affect the vertebral body (front of the spine) most often in the upper lumbar or lower thoracic spine but the pain associated with these types of fractures frequently radiates into the low back and pelvic region. In the elderly osteoporotic spine, these types of fractures usually do not result in spinal cord injury or nerve damage but this is quite the opposite when compression fractures occur in younger, normal bone density individuals. This is because when the bone is dense (or normal), the vertebral body basically explodes or bursts shifting some of the bony fragments back into the spinal canal where the spinal cord is located. When bone density decreases, there is no bursting of fragments – only collapse, resulting in pain but no neurological damage. Besides pain, another problem with compression fractures is that the once upright or vertical spine is now bent and angles forward shifting the patient’s weight to the front. This shift places yet more pressure on both the fractured vertebra and the surrounding vertebra which increases the risk of fracture to the surrounding adjacent vertebra. Therefore, multiple compression fractures are not uncommon when brittle bones occur from osteoporosis.

So who is more at risk for osteoporosis? The usual predictors include age, (older than 65), gender (female), race (Asian or Caucasian), low body weight, and previous fracture. Others include smoking, previous use of corticosteroids, a family history of fracture, excessive alcohol use, and rheumatoid arthritis. Additionally, vitamin D deficiency, thyroid or parathyroid increased function, and celiac disease (gluten intolerance) as well as poor balance (repeated falls), muscle weakness and a DEXA (dual-energy X-ray absorptiometry) T-score of -1.1 to -2.4 (osteopenia) or -2.5 or greater (osteoporosis) are also important predictors of brittle bone disease or osteoporosis. To best determine your risk using these factors, go to FRAX (www.sheffield.ac.uk/frax) developed by the World Health Organization (WHO) to determine your 10-year fracture probability (do not just use of the T-score on the DEXA scan).

Video: Bone Density Screening

From a treatment standpoint, it depends on the age of the patient, the degree of osteoporosis, and whether fracture has already occurred. In the younger, osteopenic person (that is, no fractures have occurred yet but bone density is low), non-medication approaches such as weight bearing exercise, no smoking, calcium / vitamin D supplementation, and minimize the other risk factors described above may be the proper choice. For others already with fracture, medication (bisphosphonates such as Actonel, Boniva, & Fosamax) may be appropriate. Further, injecting a cement into the bone (called kyphoplasty) may be appropriate for some.

We realize you have a choice in healthcare providers. If you, a friend or a 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.

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome:
Why Braces?

For those of you who have had Carpal Tunnel Syndrome, you probably know all about braces. These are devices worn on the wrist that stop you from bending the wrist up or down. They may be worn anytime of the day if they don’t interfere too much with one’s current activity but are especially worn at night. One might think it would be more important to wear these during day when we are active and moving our fingers and hands a lot as we go about our normal work or play activities – not at night when we’re basically just laying there doing nothing but sleeping, right? Wrong! It’s more important to wear these at night. This is because we cannot control our hand/wrist position at night as we tend to curl up in a ball when we sleep and the wrist gets cocked up or down, often to the end point of the range. So, why is this so bad? To answer that question, let’s look at the chart below on the left.

      

In the chart (above left), you are looking at a cross section of the wrist through the carpal tunnel. This illustrates the many structures that are inside the tunnel making it very compact or tight. Notice the small white circles in the middle of the tunnel. Those are the tendons that pass through the tunnel – there are 9 of those and they attach the muscles in our forearms (on the palm side) to our fingers so we can shake someone’s hand or carry a suitcase (grip). Just to the left of center, on top of all the tendons sits the median nerve, which is just below the “roof” of the tunnel (the transverse carpal ligament). Now, normally, the pressure inside the carpal tunnel will approximately double when we bend our wrist, putting more pressure on the nerve and pushing it into the roof (ligament), which creates the numbness and/or weakness in our grip. But in the CTS sufferer, there is already more pressure in the tunnel due to the swollen tendons so when the wrist is flexed or extended, the pressure goes up much more the twice – more like 6 times more pressure – hence, more symptoms. So, if we’re sleeping with our wrist bent either way, the pressure pushing the nerve against the roof is a lot more than normal – 6x more! Now, can you see the reason for the “night splint?” It is VERY effective in keeping the wrist straight or “in a neutral position,” which is needed to allow the nerve to NOT be pinched so it can heal.

Video: Carpal Tunnel Syndrome

Regarding braces, there are MANY different kinds of braces available and deciding which one to use is no easy task, not to mention the fact that they come in different sizes! When you are treated for CTS at this office, we will fit you with the proper size brace, if it’s necessary. We realize you have a choice in health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

We hope this information is useful to you or someone you care about. For more information, visit us at www.newjerseypainmanagement.net or call us directly 732.719.8148 for a free consultation.

Health Update: Whiplash

Interesting Facts
About Whiplash

We all know the most common causes of “whiplash” are injuries that typically arise from automobile accidents or, motor vehicle collisions (MVC’s) although whiplash can also occur from slip and fall and virtually, any injury where your head is whipped backwards. But there are many things about whiplash you may not be aware of, which is the reason for this month’s Heath Update on whiplash.

For example, did you know the effect whiplash has on public health (in general) is tremendous? The number of cases occurring annually is frequently quoted as 1,000,000 per year, but this is based on an outdated (1971) and incomplete dataset. A more recent figure of 3 million per year is considered to be more accurate because it’s based on several governmental databases and it accounts for the expected number of unreported cases by the NHTSA (National Highway Traffic Safety Administration).  That’s a huge difference!  The updated figure accounts for whiplash victims not attended to by emergency medical services. In less catastrophic accidents, the injured party may not appear to be significantly injured at the scene of the MVC and decline emergency care and hence, the MVC will to unreported to a governmental data collection center.

Video: Whiplash Health Update




Another interesting study surveyed over 3500 chiropractors who were asked if they commonly applied cervical (neck) spinal manipulation to patients who had known herniated discs or protruded discs (in their neck). Over 90% of the chiropractors indicated they found it safe and effective to utilize cervical adjustments (manipulation) in this patient population. It is VERY important for you to know this as frequently, you may be told by your medical doctor (or next door neighbor), “…don’t let anyone crack your neck!” Now, you can rest assured that in the experience of MANY chiropractors (not just me), significant benefits can be achieved by this treatment approach.  Moreover, the sooner neck adjustments are applied, the better the results - so don’t wait to get a chiropractic treatment after an MVC!

Another interesting study investigated the “proper” or “best” seated position in a car during a rear-end collision, based on an analysis of many previously published studies on this topic.  Because the seated position of the person involved in a MVC is related to the degree of the injury, the factors studied included the angle of the seat back, seat-bottom angle, the density of the foam in the seatback, the height above the floor [of the knees], and the presence of armrests in cars.  They found that the seat back angle of 110-130 degrees reduced disc pressure and low back muscle activity but 110 degrees – MAX. – was found to minimize the forward positioning of the head. A 5 degree downwards tilt of the seat bottom further reduced the pressure in the low back discs and muscle activity as measured by an EMG Test (electromyography).  The use of armrests and the use of a lumbar support were also found to be important to reduce injuries associated with MVCs.  This combination was reported to be optimum for all of us to use in order to minimize the bodily injury in a rear-end MVC. Other important factors included firm dense foam in the seat back, an adjustable seat bottom (for angle, height, and front to back distance), horizontal and vertical lumbar support adjustments (…best if they pulsate to reduce the static load encountered in a crash), seat shock absorbers, and seat adjustments for front to back to adjust for different patient heights.

We hope this information is helpful. We realize you have a choice in where you go for your health care needs.  We truly appreciate your consideration in allowing us to help you through this potentially difficult process.

Visit us at www.newjerseypainmanagement.net or call us directly 732.719.8148 for more information and a Free consultation.