Merry Christmas, May God Bless You With Health and Happiness in the Coming Year
Dr Barry Marks, Chiropractor Orange CA
As they say, an ounce of prevention is worth a pound of cure. There are two aspects to prevention of back pain: keeping strong and flexible, and avoiding mistakes during movements.
Remember that your spine is your “core,” and the core is activated with fast-paced walking. Most of us don’t think of how the spine is affected with walking, instead focusing on the legs. Make walking part of your daily routine. Walk a few blocks or across town to run an errand, rather than getting into a car for these short trips. Park a few blocks away when you have to use the car, so that you can get in a few minutes of walking. Some of us spend five minutes circling in a parking lot just to get a space close to the front door or we get frustrated when we can’t find a space close to the gym! In contrast to sitting, which increases pressure on our disks, walking strengthens muscles and dissipates the pressure on our lower disks.
Tight muscles at the back of the thighs-the hamstrings are an often neglected area that affects the lower spine tremendously. To stretch these muscles, stand upright and put one foot on the back of a chair or sofa. Slowly bend forward and hold this position for 30-40 seconds. It should cause a tight burning pain at the back of the leg. It should not cause a shooting pain down your leg, or increase pain in the lower spine. If it does, then see a health care provider immediately. When the hamstrings are flexible, this allows the pelvis to rotate forward when you bend over. If the hamstrings are not flexible, then the lower spine will bend too much to accomplish any lifting task.
The second aspect to preventing back pain is avoiding mistakes, such as lifting with your back, instead of your legs. This is especially true if an object is very heavy. Sometimes the object is light, but we lift in an awkward position, standing with most of our weight on one leg, then bending and twisting, such as getting grocery bags from a back seat, or moving and positioning a child safety seat. Especially avoid twisting motions of the lower spine while bending over. Also, use one of your hands to help brace your spine, which will decrease the pressure on your disks.
Your “back pain” might be a misnomer. We often confuse pain for a problem. Doctors often don’t help matters by not doing thorough examinations, and just offering a prescription of pain pills or anti-inflammatory drugs when the patient comes in with a complaint of pain.
So what is the difference? The pain is part of the problem you are experiencing, but it is not the actual cause-the problem that is producing the pain. If you say you have back pain to a doctor, this should be the starting point for a complete examination to determine its cause. Is it a problem with the disk (a cartilage ligament that separates the vertebrae)? Is the problem more a muscle strain? Do the joints of the spine move in a free and symmetrical pattern?
Have you been examined this way? Was your spine moved around in different planes? Did the doctor poke and press on different tissues of the spine to see if there was swelling (inflammation) or tenderness? Were x-rays taken to see if there was normal alignment and good posture of your spine?
All of these tests help to determine the actual nature of the problem. It’s not enough to just call the pain the problem and leave it that. Sadly, this happens to far too many patients who are left thinking that if they just take something to cover up the pain, it makes the problem go away.
Our office is different, we examine to find the cause of your pain, and then provide a treatment plan that can get you back to enjoying your activities with maximum function. We offer a variety of treatments and make recommendations that are best suited to your particular problem. You may only need a chiropractic adjustment or two or you may need a series of spinal decompression treatments to rehabilitate your discs. It all depends on your exam findings and your needs. And of course you are alwasy in control of what type and how much treatment you receive in our office.
Of course, taking pain pills for long periods of time can also lead to undesired side effects such as stomach bleeding. We are very conditioned in society to accept pills as the source of health and longevity. For many patients they are critical to regaining health, but too often they are used as a panacea, especially when it comes to back pain. You should ask questions about a doctor’s approach to getting you well, and whether this fits with your philosophy and preferences. See our recent post on the dangers of pain killers here.
For more information about low back pain and a Free Back Pain Evaluation call (714) 938-0575 or fill out the form in the right side bar.
Low back pain can arise from many conditions, one of which is a mouthful: spondylolisthesis. The term was coined in 1854 from the Greek words, “spondylo” for vertebrae and “olisthesis” for slip. These “slips” most commonly occur in the low back, 90% at L5 and 9% at L4. According to www.spinehealth.com and others, the most common type of spondylolisthesis is called “isthmic spondylolisthesis,” which is a condition that includes a defect in the back part of the vertebra in an area called the pars interarticularis, which is the part of the vertebra that connects the front half (vertebral body) to the back half (the posterior arch). This can occur on one, or both sides, with or without a slip or shift forwards, which is then called spondylolysis. In “isthmic spondylolisthesis,” the incidence rate is about 5-7% of the general population favoring men over women 3:1. Debate continues as to whether this occurs as a result genetic predisposition verses environmental or acquired at some point early in life as noted by the increased incidence in populations such as Eskimos (30-50%), where they traditionally carry their young in papooses, vertically loading their lower spine at a very young age. However, isthmic spondylolisthesis can occur at anytime in life if a significant backward bending force occurs resulting in a fracture but reportedly, occurs most frequently between ages 6 and 16 years old.
Often, traumatic isthmic spondylolisthesis occurs during the adolescent years and in fact, is the most common cause of low back pain at this stage of life. Sports most commonly resulting in spondylolisthesis include gymnastics, football (lineman), weightlifting (from squats or dead lifts) and diving (from over arching the back). Excessive backward bending is the force that overloads the back of the vertebra resulting in the fracture sometimes referred to as a stress fracture, which is a fracture that occurs as a result of repetitive overloading over time, usually weeks to months.
If the spondylolisthesis lesions do not heal either by cartilage or by bone replacement, the front half of the vertebra can slip or slide forwards and become unstable. Fortunately, most of these heal and become stable and don’t progress. The diagnosis is a simple x-ray, but to determine the degree of stability, “stress x-rays” or x-rays taken at endpoints of bending over and backwards are needed. Sometimes, a bone scan is needed to determine if it’s a new injury verses an old isthmic spondylolisthesis.
Another very common type is called degenerative spondylolisthesis and occurs in 30% of Caucasian and 60% of African-American woman (3:1 women to men). This usually occurs at L4 and is more prevalent in aging females. It is sometimes referred to as “pseudospondylolisthesis” as it does not include defects in the posterior arch but rather, results from a degeneration of the disk and facet joints. As the disk space narrows, the vertebra slides forwards. The problem here is that the spinal canal, where the spinal cord travels, gets crimped or distorted by the forward sliding vertebra and causes compression of the spinal nerve root(s), resulting pain and/or numbness in one or both legs. The good news about spondylolisthesis is that non-surgical approaches, like spinal manipulation in particular, work well and chiropractic is a logical treatment approach!
Learn more about spondylolisthesis diagnosis and treatment at http://drmarks.com
The normal curves of the spine include an inward curve in the low back and neck and an outward curve in the mid-back when looking at the person from the side (“sagittal plane”). However, there should NOT be any curves when looking at a person from the front or back (the frontal plane), the spine should be straight. When there is a curve in the frontal plane, this is called scoliosis and it’s usually either a singe curve, shaped like the letter “C” or, a double (or more) curve, shaped like the letter “S”. Though there is a diagnostic code specific for scoliosis, it is not in itself a disease or a diagnosis and frequently, there are no or at worst, minimal symptoms associated with it. For this reason, most of the time, scoliosis is not noticed until the curve progresses significantly and a friend or family member makes a comment about it or a school screening picks it up.
…but it can also be located at the junction between the mid back and low back, as well as in the low back only or more rarely, in the neck only. Since there are rarely symptoms associated with scoliosis, the way it’s found is by observing one or more of the following:
The use of x-ray usually is appropriate to confirm the diagnosis, to measure the amount of curve, which can then be used for future comparison, and to rule out a possible unusual cause of scoliosis. Rarely is an MRI required – only in cases where neurological signs and symptoms exist and, in younger children (ages 8-11 years old) as scoliosis almost always occurs during the puberty time frame when hormonal systems are kicking in, such as ages 12-14. When scoliosis occurs at ages less than 11, when there are neurological changes (reflex, muscle strength and/or sensory functions), and/or when the mid-back/thoracic curve bends to the left (as it almost always curves to the right), an MRI is appropriate to rule out spinal cord pressure.
1) The “skeletal maturity of the patient” (how much growing is left for the person)
2) The degree of the curve. In general, the bigger the curve and the younger the patient, the greater the chance for curve progression or worsening. With that said, curves less 10° reportedly don’t require treatment but over 20° should be watched at 4-6 month intervals. If a curve progresses >5° and/or when the curve is >30° in an adolescent, the person should be treated – most doctors would utilize a back brace. Chiropractors can offer additional care by applying spinal adjustments, reducing leg length deficiencies when a compensatory lumbar/low back curve is present and by offering scoliosis-specific exercises.
For a FREE Scoliosis Screening call (714) 938-0575 or go to http://drmarks.com and click on “Appointments” for a Free Consult and Computer Spinal Analysis
