Dr. Glenn Hyman’s Denver Chiropractic Center- 90 second post run stretch session
Help prevent back pain, hip pain and knee pain by regularly using these simple stretches! Happy Running.
Dr. Glenn Hyman
Denver Chiropractic Center
303.300.0424
Help prevent back pain, hip pain and knee pain by regularly using these simple stretches! Happy Running.
Dr. Glenn Hyman
Denver Chiropractic Center
303.300.0424
Most people don’t realize how complicated the low back region is when it comes to investigating the cause of low back pain (LBP)? There can be findings on an x-ray, MRI, or CT scan such as degenerative disk disease, arthritis, even bulging and/or herniated disks that have NOTHING to do with why the back hurts. Similarly, there are often other abnormal findings present in many of us who have NO low back pain whatsoever! Because of this seemingly paradoxical situation, we as clinicians must be careful not to over-diagnose based on the presence of these “abnormal findings” AND on the same hand, be careful not to under-diagnose them as well. Many of you know it can be quite tricky.
Looking further into this interesting paradox, one study reported findings that support this point. Investigators examined 67 asymptomatic individuals who had NO prior history of low back pain and evaluated them using magnetic resonant imaging (MRI). They found 21 of the 67 (31%) had an identifiable disk and/or spinal canal abnormality (which is where the spinal cord and nerves run). Seven years later, this same group of non-suffering individuals was once again contacted to see if they had developed any back problems within that time frame. The goal of the study was to determine if one could “predict” who might develop low back pain based on certain abnormal imaging findings in non-suffering subjects. A questionnaire was sent to each of these individuals, of which 50 completed and returned the questionnaire. A repeat MRI scan was performed on 31 of these subjects, and two neurologists and one orthopedic spine surgeon interpreted the MRI studies using a blinded approach (without having knowledge about the subject’s symptoms or lack thereof). Each level was assessed for abnormalities including disk bulging/herniation and degeneration. Those who had initial abnormal findings were defined as “progressed” (worsened) if an increased severity of the original finding was evident or if additional or new spinal levels had become involved over the seven-year time span.
Of the 50 who returned the questionnaire, 29 (58%) had NO low back pain, while 21 had developed LBP. In the original group that had the MRI repeated seven years later, new MRI findings included the following: twelve remained “normal,” five had herniated disks, three had developed spinal stenosis, and one had “moderate” disk degeneration. Regarding radiating leg pain, four of the eight had abnormal findings originally, two of the eight had spinal stenosis, one had a disk protrusion, and one an “extruded” (“ruptured”) disk. In general, repeat MRI scans revealed a greater frequency of disk herniation, bulging, degeneration, and spinal stenosis compared to the original scans. Those with the longest duration of LBP did NOT have the greatest degree of abnormalities on the original scans. They concluded that the original MRI findings were NOT PREDICTIVE of future development of LBP.
They summarized, “…clinical correlation is essential to determine the importance of abnormalities on MR images.” These findings correlate well with other studies, such as 50% or more of all asymptomatic people HAVE bulging disks and approximately 30% of us have herniated disks – WITHOUT PAIN. To be of diagnostic (clinical) value, the person MUST have signs and symptoms that agree with the imaging test, which is used to CONFIRM the diagnosis. Bottom line, If you have LBP, come see us, as we will evaluate and treat YOU, NOT your x-rays (or MRI) findings!
If you, a friend, or family member requires care for back pain, we would be honored to help. Simply call us at 303.300.0424, or use the “Make An Appointment” link on our website at denverback.com
Headaches (HA) play a significant role in a person’s quality of life and are one of the most common complaints that chiropractors see. This comes as no surprise, as one survey reported 16.6% of adults (18 years and older) suffered from migraines or other severe headaches during the last three months of 2011. Another study reported that head pain was the fifth LEADING CAUSE of emergency department (ED) visits in the United States and accounted for 1.2% of all outpatient visits. These statistics are even worse for females (18-44 years old), where the three month occurrence rate was 26.1% and the third leading cause for ED visits! Because of the significant potential side effects of medications, many headache sufferers turn to non-medication treatment approaches, of which chiropractic is one of the most commonly utilized forms of “complementary and alternative approaches” in the management of tension-type headaches. So, why are headaches so common? Let’s talk about posture!
Posture plays a KEY ROLE in the onset and persistence of cervicogenic headaches. If there is such a thing as “perfect posture,” it might “look” something like this: viewing a person from the front (starting at the feet), the feet would flair slightly outwards symmetrically, the medial longitudinal (inside) arch of the feet would allow enough space for an index finger to creep under to the first joint (and NOT flat like so many), the ankles would line up with the shin bones (and NOT roll inwards), the knees would slightly “knock” inwards and hips would line up squarely with the pelvis. The shoulders would be level, the arms would hang freely and not be pronated (rolled) inwards, and head would be level (not tilted). From the side view, the knees would not be hyperextended nor flexed, the shoulders would not be forward (protracted) and MOST IMPORTANT (at least for headaches), the head would NOT be forward and be able to have a perpendicular line drawn from the floor through the shoulder, as this line should pass through the outer opening of the ear. As the head “translates” or shifts forwards, for every inch of “anterior head translation” (AHT), it essentially gains 10 pounds in weight, which the upper back and neck muscles have to counter balance!
A leading University of California medical author, Dr. Rene Calliet, MD, wrote that this altered posture can add up to 30 pounds of abnormal weight to the neck and can “…pull the entire spine out of alignment.” It can also reduce the lung’s vital capacity by 30%, which can contribute to all sorts of breathing-impaired health problems! Think of carrying a 30-pound watermelon around your neck all day – the muscle pain from fatigue would be tremendous! If this is left uncorrected, chronic neck pain and headaches from pinching off the top three nerves in the neck is likely. The combination of AHT and shoulder protraction may also lead to the development of an upper thoracic “hump” and potentially into a “Dowager Hump” if the Midback vertebrae become compressed (wedged). An increased rate of mortality of 1.44 is reportedly associated with this faulty posture!
Between chiropractic adjustments, Active Release Techniques Soft Tissue Treatments, posture retraining exercises, other postural corrective care, and strength exercise training, we WILL help you correct your faulty posture so that neck pain and headaches STOP and don’t progress into a chronic, permanent condition.
If you, a friend, or family member requires care for headaches, we would be honored to help. Simply call us at 303.300.0424, or use the Appointment Request function on our website at denverback.com
Last month, we started the discussion of self-care options in the management of car accident injuries: whiplash or CAD (cervical acceleration-deceleration) or WAD (whiplash associated disorders). In this series, we are describing various treatment methods that you can be taught to help facilitate in the management process during the four stages of healing (acute, subacute – discussed last month; remodeling and chronic – addressed this month).
Like in the acute and subacute stages, many of the same self-care techniques can be applied here as well. You will NEVER “hurt” yourself with ice or ice/heat combinations (done properly), so they can be continued indefinitely. Many patients find this helpful. Using the analogy of a cut on the skin, in the acute stage, the cut is fresh and new. It is quite pain sensitive and unstable and it will continue to bleed if you don’t take it easy. After 72 hours (entering the subacute stage), the wound has an immature scab on it and it can still easily be re-injured, and if this occurs, especially by NOT self-managing properly, the recovery time can be significantly prolonged. So, “DON’T PICK AT YOUR CUT!!!” As we enter the later subacute phase (fourteenth week), the wound’s scab is quite mature, and self-care can be appropriately more aggressive. Think strengthening and activity restoration!
Stage 3 – REMODELING phase (14 weeks to 12 months or more): In this stage, we are now three months to a year out from the injury date and hence, we SHOULD now be more “aggressive” with care. During the late acute and subacute stages, you would have been performing exercises focused on movement restoration (range of motion / ROM exercises with LIGHT resistance) in addition to self-applied myofascial release techniques using foam rolls, tennis balls, TheraCane, and/or the Intracell (and possibly others). It is NECESSARY to continue the use of these methods, as they help reduce the chances for any scar tissue to become permanent. In this stage, we will guide you into more advanced exercises that include aerobics (walking, walk/run combinations, etc.) as studies show that whole body aerobic exercise helps MANY specific area injuries, including WAD/CAD injuries.
Stretching short/tight muscles, working on balance-challenging exercises (rocker or wobble boards, balance beams, gym balls, eyes closed specific action movements) are VERY IMPORTANT, as they retrain your neuromotor system and reintegrate neural pathways that have been disrupted by the injured tissues and retrain faulty movement patterns you’ve developed from compensating due to pain. Strengthening exercises will include the core since the head sits on the neck, the neck on the trunk, the trunk on the legs, and ALL of this sits on the feet (so we’ll even consider stabilizing the sub-talar joint at the ankle and if pronation is excessive, foot orthotics can help whiplash patients)!
Stage 4: CHRONIC (Permanent): ALL OF THE ABOVE can be employed after the one to two year point to “maintain” your best level of function. If you still have pain, try to “ignore it” and KEEP MOVING, stay active, stay engaged in work, family activities, and DON’T let the condition “win.” AVOID CHRONIC DISABILITY by staying active and fit!
We realize you have a choice in whom you consider for your health care. If you or someone you know needs help recovering from car accident injuries, call us at 303.300.0424, or use the “Make an Appointment” function on our website www.denverback.com.
Whiplash is a condition that can occur from MANY causes – in fact, anything that results in a sudden change in the head/neck position. Usually, there is a rapid acceleration that injuries the soft tissues around the neck area by stretching them beyond their limits. Hence, the more accurate terms for whiplash are, “cervical acceleration-deceleration” or CAD as it describes the mechanism of the injury and “whiplash associated disorders” (WAD) describing the degree of injury.
Most commonly, when we think about whiplash, we immediately envision a motor vehicle collision (MVC), but prior to the invention of the automobile, the term “railroad spine” was coined to describe injuries to the neck from crashes that occurred between trains. Since then, due to pilots landing planes on aircraft carriers, sports injuries, and the rise of the automobile, this once rare condition has affected MOST of us at some point in time!
Today’s topic will focus on self-care. What can you and I do for ourselves WHEN we suffer a CAD injury? Since there are different levels of injury severity, keep in mind that EACH CASE IS UNIQUE and we will ONLY be discussing general options. So ALWAYS let your symptoms guide you in the process of care – that is, if you feel a sharp, piercing/stabbing, activity or movement stopping type of pain, STOP!!! Don’t further injure your tissues!!! We will discuss a common WAD II injury (soft-tissue injury limiting motion but not injuring nerves) and we’ll look the acute and sub-acute stages of the injury.
Stage 1 – ACUTE: The inflammatory phase (up to 72 hours). ICE is necessary to decrease swelling (inflammation). Limit motion but try NOT to use a collar unless you have no choice as even small movements that avoid the sharp/knife-like pain are better than no movement at all. A collar may be needed when driving (especially if the roads are bumpy)! Anti-inflammatory herbs like ginger, turmeric, boswellia, bioflavonoid, and others reduce inflammation WITHOUT irritating the stomach, liver, kidneys, and will NOT inhibit the chemicals needed for healing (like NSAIDs do!). Chiropractic care with Active Release Techniques Soft Tissue Treatment SHOULD begin ASAP after an injury. We may only use gentle manual traction and/or mobilization, also staying within reasonable pain boundaries. It’s been well proven that early movement is best!
Stage 2 – SUB-ACUTE: The repair phase (72 hours to 14 weeks). Ice can continue if it helps control pain. You can also alternate ice and heat at 10/5/10/5/10 minutes, starting and ending with ice (it “pumps” the tissues). Cervical range of motion (ROM) exercises with LIGHT resistance (use 1 or 2 fingers against the head and push in a forward, backward, sideways, and rotating directions first with “isometrics” – not moving the head, and when tolerated, “isotonic” – moving the head against the LIGHT pressure applied in BOTH directions within the range that avoids sharp/knife-like pain. Movement, strength, pain, and coordination are ALL better managed when light resistance + motion is used vs. not moving (isometrics). Self-applied methods of performing “myofascial release” (which we will teach you) include: Self-massage, the use of a tennis ball and/or foam roll and others. During this repair phase, chiropractic adjustments and Active Release Techniques Soft Tissue Treatments REALLY help!!! We will continue this discussion on the next page…
Evidence from many trials and many research projects clearly demonstrates the superiority of chiropractic services over standard medical care and even traditional physical therapy in the treatment of musculoskeletal conditions:
Low back pain (LBP) is a reality in most of our lives at one point or another. It can range from being a “nag” to being totally disabling. While we use Active Release Techniques and traditional chiropractic adjustments at Denver Chiropractic Center, home exercise is an important part of our protocol.
Let’s look at some exercises for the low back that can be done from a SITTING position so that they can be: 1) Performed in public (without drawing too much attention) and 2) Repeated every one to two hours with the objective to AVOID LBP from gradually getting out of control (STOP the “vicious cycle” so LBP stays “self-managed”).
RULES: 1) DON’T do any exercise that creates SHARP pain; 2) Stay within “reasonable” pain boundaries; 3) DO these multiple times a day WHEN you feel tight, stiff, sore (take 10-30 sec. every hour rather than 15 min. twice a day).
SITTING LOW BACK EXERCISE OPTIONS:
1) SITTING BEND OVERS: 1) Slowly bend forward from a seated position and attempt to reach the floor; 2) Spread the knees as needed to allow for a full range of motion; 3) Hold for 3-10 seconds or until it feels “loose.” 4) Do the opposite – sit and arch your low back as far back as is comfortable. Repeat frequently for short hold-times – make it “fit” your time limitations/schedule!
2) SITTING HIP / BACK STRETCH: 1) Cross your leg; 2) Raise the knee to the opposite shoulder; 3) Arch the lower back until you feel an increase stretch in your buttocks; 4) Twist your trunk to the side the knee is raised; 5) Move your knee up/down and around to “feel” for the tightest “knots” and “work” them loose; 6) Modify by bending forward 7) REPEAT on the opposite side.
3) SITTING TRUNK ROTATIONS: 1) Slowly twist your shoulders and trunk to one side while keeping your knees straight; 2) Reach back and pull for additional stretch if comfortable; 3) Hold for 3-10 seconds or, until it feels “loose;” 4) REPEAT on the opposite side.
Remember, DO these MANY times a day (at least once every hour). We have many others as well (ask us)! We realize you have a choice in whom you consider for your health care and we sincerely appreciate your trust in choosing Denver Chiropractic Center for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?
A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.
So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!
Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!
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A pilot study involving 77 patient with chronic spinal pain received either nonsteroidal anti-inflammatory drugs (NSAIDs), acupuncture, or spinal manipulation. After 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements according to outcome assessments.
Journal of Manipulative Physiologic Therapeutics, July 1999
A year-long study compared chronic sciatica patients with symptomatic lumbar disk herniations who received either a microdiskectomy or 21 chiropractic visits. The researchers found that 60% of the patients who received chiropractic care benefited to the same degree as those who underwent surgery. The study’s authors recommend that patients with a symptomatic lumbar disk herniation try chiropractic first, before considering surgery.
Journal of Manipulative Physiologic Therapy, October 2010