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.