Health Update: Low Back Pain

Simple “On-The-GO” Low Back Exercise

    “Doc, I try to do my exercises but I have to hit the ground running in the morning….to get the kids ready for the school bus….I have morning meetings….I’m not a morning person….I’m pulled in 100 directions during the day….I forget about them until I’m in bed….I exercise on my job and that’s enough…."

    I’m sure we’ve all rationalized our inability to keep up with exercises, especially after our episode of low back pain (LBP) subsides. In fact, only about 4% of LBP patients continue doing their exercises after their pain subsides. That means 96% of us with chronic, recurring low back pain DO NOT exercise even though we know we should.  We feel bad, even guilty for not exercising.  So, what can we do to “trick” ourselves into being more compliant with our low back exercises?

    First, let’s accept the fact that most of us cannot consistently “fit in” exercise into our busy schedules.  With that said, the TIMING of when to do the exercise may be more important than even doing them at the same time every day. In other words, do a few exercises when you need them the most. For example, if you’re working at a computer for more than 1 hour, and you start to feel back pain from the prolonged sitting – especially if your work station set up is less than ideal – do one or two sitting exercises right at your work station, BEFORE your back pain gets any worse. If you wait too long, the exercises may not be of much benefit. Setting a timer next to your screen that beeps every hour is a good reminder to do one or two simple exercises and only takes a minute or two.  Many inexpensive digital watches can be set to beep on the hour/every hour or, you can set a “timer” to beep after 60 minutes as a “gentle” reminder.  Some cell phones also have a timer feature. Here are three sit down low back exercise options (try them all and decide which one(s) feel most productive/helpful):

1.    “Crossed Knee Stretch”: Cross your legs; pull the crossed knee towards your opposite shoulder (feel the pull in your buttocks); arch your low back and at the same time, twist or rotate to the side of the crossed knee. Hold for 5-10 seconds and repeat up to 3 times.  Repeat this on the opposite side.
2.    “Sit Twists”: Reach across with your right hand and grasp your left leg at mid-thigh. Twist/rotate your back to the left and pull with your arm. Hold 5-10 seconds / repeat 3 times. Repeat this on the opposite side.
3.    “Sit Floor Touches”:  Bend over as if to touch the floor or tie a shoe.  Hold 5-10 seconds.

    If you do the math, it would take a minute for #1 and #2, 30 seconds for #3 (total 2.5 min.).  If that’s too long, hold for 5 seconds.  If that’s too long, do 1 rep, not 3.  You get the idea…..MAKE IT WORK!  Modify the dose to fit your schedule or ability to stretch.  If you do this AT THE TIME you start to feel tight or sore, you can PREVENT a LBP episode!

    Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy.  To find out if you are a candidate for their customized treatment approach call 732.719.8148 or visit www.advanced-wellness.net.

Health Update: Whiplash – Can This Affect My Memory?

Whiplash – Can This Affect My Memory?

"Doctor, is it normal for people after a whiplash injury to notice problems with memory. I can’t seem to remember things I just recently did since my car accident?”

This is a common complaint occurring as a result of a whiplash injury, but it’s not commonly known, leaving those who are suffering wondering, “…what’s wrong with me?” Whiplash is an injury that classically occurs as a result of a car crash at any speed, even at low speed! This is because at low speed, there is little to no damage to the car, and the forces from the crash are not absorbed by the crushing metal. As a result, those forces are transferred to the contents inside the car – that is, the passengers. This sometimes results in a significantly greater injury compared to crashes that occur at twice the speed because the latter results in crushing metal. The actual injury that occurs in whiplash is caused by the sudden, rapid movement of the head resulting in varying degrees of injury to the neck, as well as to the contents inside the skull – that is, the brain. The brain literally “bangs” into the inside walls of the skull when the head is rapidly accelerated during a car crash. The resulting injury is a concussion. What’s interesting is that most patients injured in a car crash often don’t mention a concussion nor is it usually asked about at the doctor’s office as other, more obvious injuries are dwelt with. The condition is usually referred to by one of two names: post-concussive syndrome or mild traumatic brain injury (MTBI).

"Doctor, when I’m reading a book or magazine, sometimes I have to re-read the passage several times before it sinks in. It’s as though I lose my concentration and I can’t focus on what I just read. The other day, I was talking to a group of co-workers and I lost my place in the middle of the discussion and had to ask, ‘…now where was I?’ I notice this is happening a lot since the car accident.”

This can be very embarrassing, frustrating, and scary for patients suffering with MTBI. Other symptoms associated with this include difficulty in focusing (blurred vision), headaches, having difficulty in pronouncing certain words (“tongue twisted”), having difficulty in understanding what was said, difficulty remembering numbers or groups of numbers like phone numbers, addresses, birthdates, and so on. These symptoms can range from mild to severe and can be very disruptive, making work and everyday tasks challenging.

How long does it last? MTBI can completely clear up in 2 to 6 months without problems or, it can hang on for 2 years or longer, and may even become a permanent residual from the car crash. In one study, continued problems after a 2 year time frame were reported in close to 20% of those injured 2 years earlier. This study suggests that about 1 out of 5 may continue to suffer with MTBI and the associated brain-related problems for at least 2 years following a car crash. However, another study reported the long term “higher cognitive function” (such as the ability to communicate through written or spoken language) is usually not affected by whiplash injuries. However, they preface that with by reporting that a more commonly injured group with more mild brain problems was found.

As chiropractors, we are trained to do a thorough history, orthopedic and neurological examination, and ask specific questions about mild traumatic brain injury. It is important to discuss this information with those suffering from whiplash injuries as frequently, MTBI patients think something is “…seriously wrong” and harbor unnecessary anxiety.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH

FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597

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 push-up ("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.
                                                        
YOU MAY BE A CANDIDATE FOR OUR LOW BACK PAIN PROGRAM.  FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597 OR VISIT US AT ADVANCED-WELLNESS.NET

What is spinal decompression therapy?

Spinal decompression is a non-invasive, non-surgical treatment for certain types of chronic back pain.  Mechanical decompression works by slowly and gently stretching the spine, taking pressure off compressed discs and vertebrae. Spinal decompression is one of the most exciting medical treatments developed in many years, since it demonstrates good statistical results for long term pain relief.

The most common spinal condition treated with decompression treatment is a herniated disc. Spinal compression can cause disc herniations to expand, putting pressure on surrounding spinal nerve roots Decompression treatment takes the pressure off these damaged discs so that the disc bulge will shrink back closer to its original size.

Degenerative disc disease is also a common condition treated with decompression therapy. Loss of disc height can be exacerbated by spinal compression, causing the vertebral bodies to move closer together. This can cause nerve compression and other forms of common back pain. Decompression eliminates the overwhelming pressure on degenerated discs reducing or eliminating painful symptoms.

Facet joint syndrome is yet another condition treated with spinal decompression. Facet syndrome causes pain due to arthritic changes in the vertebral bones. Decompression helps to create more space between the vertebrae, hopefully reducing painful symptoms.

In order to determine if you are a candidate for spinal decompression a thorough history, exam and review of diagnostic tests including MRI’s will be necessary.  Once accepted a typical decompression program is 4 to 8 weeks in duration.  Over this period 12 to 20 treatment sessions are performed.  Each treatment session is approximately one hour long and includes any necessary physical therapy services.

A spinal decompression program may be covered by health insurance plans.  Each plan must be verified and discussed with patients on an individual basis.  It is important to choose a practice that has both expertise in spinal decompression and utilizes the most advanced spinal decompression technology.  The DRX 9000 and the Vax D are the industry leaders in this technology.

Dr. Cilea is the president of Advanced Wellness.  Advanced Wellness has been a leader in spinal decompression in Central New Jersey with over a thousand patients treated over the past 5 years.  They utilize the DRX 9000 technology.  To learn more about spinal decompression visit www.AdvancedDRX.com or call 732-984-9594 for a free consultation.

Health Update: Whiplash Part 2

Whiplash – What Is It?

Whiplash is a slang term for an injury to the neck that occurs as a result of a sudden jolt, classically occurring in a car accident though a slip and fall injury can sometimes result in a similar condition.  In a classic rear-end collision, the car is struck from behind and accelerated forward at speed that even if the person knew the impending collision was about to take place, bracing the body prior to impact would not prevent injury.  In fact, muscles can only be voluntarily contracted at around 800-1000 msec. and in a rear end collision, the head is “whipped” within a 300-400 msec. time frame.  Add to that, the muscles in the front of neck are initially stretched with the car is propelled forward leaving the head in a relatively extended backwards position.  Most of the headrests in cars are not properly positioned so the head often goes back much farther than the limits of our muscles, ligaments and joints may allow resulting in stretching and tearing of these tissues.  When the tissues in the front of the neck are over stretched, the “rubber band” effect propels the head forward - overstretching the muscles, ligaments, and joints in the back of the spine.  This “crack the whip” phenomenon occurs within 400-500 msec., far quicker than what we are capable of when voluntarily contracting our muscles. Here is a breakdown of what happens in a 5 mph rear-end collision:

0 msec.: At the moment of impact, the car seat just begins to move and the occupant has not yet been accelerated forward.
50 msec.:  As the back of the car seat pushes the torso forward, the spine moves forward, resulting in a straightening of the thoracic and cervical spine. About 2-3 G’s of force are exerted on the torso.
75 msec.:  This difference in motion between the neck and torso results in an S-shaped curve, where nearly all of the bending in the cervical spine takes place in the lower cervical spine.  This rapid bending in just a few joints can result in ligament damage in the lower spine.
150 msec.: Here, the torso has pulled so far forward on the lower neck that the head is forced backwards often over the head restraint.  Depending on the position of the headrest, the angle of the seat back, and “spring” effect of the seatback, the ligaments in the front portion of the spine are often injured during this phase of the collision.  About 3-4 G’s are exerted on the shoulders.
200 msec.:  Finally, the force of the car seat throws the head and torso forward. Here, 5 G’s are exerted on the head and neck as it whips forwards.  All of this is completed in less than 500 msec.

One of the reasons this occurs has to do with the ability of the car – particularly the back bumper to not deform so that the force of impact is transferred directly to the contents within the vehicle (ie., the passengers).  At higher speeds, the crushing metal absorbs some of the impact and the contents are actually less jostled and thrown about.  This helps explain how a no damage rear end collision can result in greater injury than a higher speed collision.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this Advanced Wellness in Marlboro.

Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy.  To find out if you are a candidate for their customized treatment approach call 732-719-8148 or visit www.advanced-wellness.net.

New Headache Study Shows the Benefits of Chiropractic Care by Dr. Joseph Cilea


Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

Call Now 732-431-2155

Herniated Disc? Now what?

Not so long ago a diagnosis of a herniated disc often had you heading for an open surgery with a long recovery. This is no longer the case. In fact, it is most important to always verify the true cause of your pain or symtoms. For example, in many instances it may not be the disc causing the problem. We now know many people have disc herniations and are totally asymptomatic. There are many techniques and methods to determine and verify the true cause of your pain. The good news is there are many minimally invasive procedures such as spinal decompression, such as the DRX9000 or endoscopic disectomies that have patients regain their lives. It is important to make sure you seek out conservative options first prior to undergoing more invasive procedures.

Back pain to be concerned about

90% of Americans will suffer an episode of back pain in their lifetime. It is important to determine when medical action is needed. Back pain can be categorized into radiating and nonradiating or centralized back pain. Non radiating back pain is often caused by spinal misalignment, muscle spasms or facet irritaion. This type of pain is often uncomplicated and can be resolved fairly quickly with conservative hands on therapies. Radiating back pain is often more complex and can be more serious and chronic. Many times the radiation is caused by a herniated disc or nerve related issue. It is important to seek medical care to get a proper diagnosis so the appropriate treatment can be performed. A very serious condition called cauda equina syndrome is a medical emergency and is associated with bowel or bladder issues in conjuction with back pain. Back pain that lasts more than a few days will only create bigger problems down the road in the future so don't ignore the signs.

What is functional training?

The days of working out "body parts" are a thing of the past. For example, working out your back and biceps on one day and your chest and triceps on another. This methodology, although good for muscular growth, does not translate to real life activities. So what we create are muscular people who are not able to perform integrated movements successfully. In other words these people can lift heavy weight in one plane or direction but when you put the person in real life situations, where they need to move at certain angles, they cannot perform them and are subject to spine or joint injuries. Working out should prepare your body to prevent injury and pain syndromes and increase performance in everyday MOVEMENTS such as lifting, bending, reaching etc. In functional training the difference is in training movements and not muscles. When you train movements you integrate several muscle groups at the same time, strengthen your core and prepare the body for real life movement and performance.