Lower Back Pain

primehealthchannel.com

LUMBAR FACET IRRITATION
Reach behind you and feel the centre of your back, just above the buttocks. This is your lumbar spine. Lumbar facet irritation usually is a painful condition affecting the joints. These are responsible for connecting the spine with protection, limiting excessive motion and preventing the vertebrae from locking together.

Patients suffering from lumbar facet irritation usually complain of a well localized low back pain, meaning they can pin-point the exact site of discomfort. The condition is closely related to lumbar facet syndrome—however, patients with the latter also feel referred pain in one hip, buttock or upper leg. Facet irritation often precedes facet syndrome, usually if someone had the irritation treated properly. The onset of lumbar facet irritation is often sudden, occurring after a misjudged movement or while recovering from a bent position. 

These activities may stretch the joint capsules (which protect and support the joints) or jam the facet joints, causing subluxations (restricted motion or abnormal positioning) in the spine and painful swelling. Other causes include poor posture, every day wear-and-tear and trauma to the low back.

Symptoms of facet irritation usually get worse when people sleep on their stomach, work with their arms above their head or rise from a sitting position. All these activities expose the joints to stress that they are not accustomed to, making them more vulnerable to injury and irritation.

Chiropractic is effective for lumbar facet irritation and syndrome. Chiropractors perform a procedure called spinal manipulative therapy, also known as an adjustment, which relieves pain and restores function to misaligned or malfunctioning joints.

Some Back Pain Statistics
• From 2000 to 2004 WorkSafeBC (Workers' Compensation Board) received over 107,000 claims for back strains.
• Back strains account for just over 25% of all WorkSafeBC (Workers' Compensation Board) claims.
• Roughly 30% to 40% of all workplace absences in Canada are due to back pain.
• Back injuries may be caused by a single instance of overexertion or develop as a result of repeated motion over time. Over two-thirds of back injuries are a result of overexer-tion.
• 60% to 90% of the population will experience low back pain in their lifetime.
• More than 90% of lower back pain cases have no specific cause (such as infection, osteoporosis, arthritis, etc
• In the health care industry, injuries due to patient handling (lifting, transferring, or repositioning) account for about 35% of all accepted time loss claims and for about 40% of claim costs.

Some common causes of stress and strain on the spine are:
• Lifting or exerting incorrectly
• Slouching in chairs
• Driving in a hunched position
• Poor posture
• Sleeping on a sagging mattress

Acute back pain is if an episode of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of treatment.

Recurrent back pain is if acute symptoms come back. Most people have at least one episode of recurrent low back pain.

Chronic back pain is if your back bothers you most of the time for longer than 3 months

Massage Therapy and Low Back Pain
Most people, in their life time, have experienced low back pain. It is one of the most common musculoskeletal disorders of today’s society. Many times, people will suffer through the discomfort, not really knowing that relief is just around the corner! Did you know that the Canadian Medical Association Journal published a study recently about low back pain and massage therapy? The conclusion was that of the people who completed the study, 63% of the people receiving comprehensive Massage Therapy reported NO PAIN after 1 month.

To read more about this study you can go to the Canadian Medical Association Journal web-site and look up the article published in the July 27th, 2000 edition.

Orthotic support for Low Back Pain
Whenever we stand, walk, or run, the lumbar spine and pelvis balance on the legs. If there are leg length inequalities, foot asymmetries, or postural misalignments exist, abnormal forces traveling up the kinematic chain will interfere with spinal (low back) function.

Most low back pain is due to some form of musculoskeletal weakness or failure. A very common source of these problems is imbalances (pronation-shifting inward) at the feet.

The feet make up the postural foundation for the body. Statistical evidence says that at birth most people have perfect feet. By age 20, 80% of humans have developed some type of problem (pronation). By age 40 nearly everyone has some kind of foot condition. Many foot problems eventually contribute to health concerns farther up the kinematic chain, especially generalized back pain.

A major factor in reducing excessive forces on the lumbar spine is often overlooked by health care professionals: the use of external supports (orthotics/heel lifts/ metatarsal pads) to decrease external forces.

Example: If a patient presents with excessive foot pronation/arch collapse, a torque force will produce internal rotation stresses to the leg, hip, pelvis and low back. The result is recurring subluxations and eventual ligament instability affecting the sacroiliac and lumbar spine joints. These forces can be decrease significantly with the use of semi-rigid, custom made orthotics.

Ribs

Anatomy of the Ribs and Spine

The neck ends at C7 and then the thoracic spine transitions into the chest area or thorax cavity. The thoracic vertebrae are numbered T1-T12—each with a pair of ribs. With ribs comes more prominent Transverse processes (the picture shows them coming off the side of T1). These transverse processes have the ribs at the end of them. The rib tip sits on the vertebral body and rests against the front tip of the transverse process. 

One pair (left and right) of ribs per thoracic level make 24 ribs or 12 pairs.

The ribs from T1-T10 make it around to the front and touch the breast bone (sternum). The Rectus Abdominus muscle (six pack muscle in the front) is where the 9-10 rib boundary is. Ribs 11 and 12 are short and are called floating ribs.

The picture shows a rib from the top. The bump sticking out is where the vertebrae joins with the rib.

At each level, the rib shape is contoured differently to define the shape of the chest.
Ribs are not horizontal, they slant downward as you trace them forward. Bands of muscles attach ribs to one another.

These muscles raise and lower the ribs like the handle of a bucket. This is the bellows with which we breathe. A sheet of muscle which seals off the bottom of the chest cavity—the diaphragm— moves upward and downward to also expand the space in the chest cavity. This is a second breathing mechanism.

Sometimes side bending spinal deviations occur which are called Scoliosis, see further.

Rib Dysfunction Syndrome
Rib dysfunction syndrome is often an overlooked condition that has identifiable signs and symptoms and responds to chiropractic adjustments. The vertebrae and the ribs of the thoracic spine make this area fairly rigid. The ribs have several distinct joints: joining them to the back area are the Costo– transverse (between rib and transverse process of vertebrae) and Costo-vertebral (between rib head and vertebral body) joints. Joining them to the front area are the Costo-sternal (between rib and sternum (for ribs 1-5) and Costo-chondral (between rib and sternum for ribs 6-10) joints.

Any of these joint areas can become misaligned due to sitting incorrectly, sleeping in an awkward position, coughing, sneezing, due to spinal curves, scoliosis, asthma, allergies and other conditions such as Scheuermann’s disease, arthritis.

You can feel tension in the upper back, shoulders, and it can lead to pain.

Scoliosis

A normal back when seen from the side is normally curved and when seen from behind is normally straight.

Some people have abnormal curves in the back and they do not have scoliosis. There is however with the abnormal curve loss of vertebral joint motion, muscle imbalances and rib restrictions.

There are different types of scoliosis. Scoliosis is not just any curvature of the spine. Only when the spinal curvature becomes a PROCESS, when the spinal curvature becomes exaggerated progressively over time do we apply the term “Scoliosis”.

The “curve” of scoliosis can be measured in several ways. The most common way is to measure in the number of “degrees”. Normally, the vertebrae are stacked as blocks that are stacked parallel to each other. If the stack bends, then the surface of one block will project an angle to the other ones. This is the angle which is measured.

Scoliosis causes the ribs to rotate, muscles to be short on one side, long on the other and vertebrae to become wedged and lose motion. This can be treated at any age and correction can occur.

Chiropractic adjustments for rib problems
When a rib loses motion or becomes restricted a person can experience a spectrum of symptoms. Sometimes it is described as a “spot in the upper back”—often it is thought it is muscular, tension in the top of the shoulder, discomfort in the chest/back, pain in the back/chest/arm, a sharp knife-like pain, sometimes there is difficulty breathing in or out deeply (dependant on which rib is restricted). Some people have a variety of tests for their heart before figuring out it is a rib problem.

The chiropractic treatment is first aimed at ruling out serious medical problems. It is then followed by a detailed examination of the joint, muscles, ligaments and tendons.

Dr. Rodwin assesses the movement of each of the individual ribs, the attach-ments to the sternum and vertebrae.

If it is found there is a loss of motion— the aim is to restore the movement, address the muscle adhesions, any postural problems or weakness are identified and a course of action is taken. Exercises are normally given to aid in helping, postural advise, and sleeping habits checked. Some female patients have had breast reductions to help reduce the strain on the muscles, ribs, vertebrae in the mid back.

Chiropractic treatment is always worth considering if you have any upper back, chest, shoulder or arm pain.

Active Release technique for muscles involving the ribs
When there are rib problems there are normally adhesions/scar tissue in the muscles, ligaments, tendons either between the ribs, the chest, in the shoulder blade area, the muscles in the top of the shoulder (secondary problem due to compensation), the shoulder and even the arm. These adhesions/scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension builds on tendons causing tendonitis and nerves become trapped. This can cause reduced range of motion, loss of strength and pain.

Active release is used to reduce the adhesions/scar tissue, which then al-lows the muscles, tendons, ligaments, and nerves to be restored to their normal resting length and function.

The Hip

Often Mis-diagnosed and left far too long! 

The hip is a stable joint, reinforced by strong ligaments, and several powerful groups of muscles. It is much easier to harm the shoulder, knee, and ankle than to injure the hip. Even so, hip problems can be highly disabling.

Daily activities such as walking down stairs, and turning in bed can be uncomfortable or painful for patients with a hip problem. The hip links to the lower extremity kinetic chain, transferring ground-reaction forces from the legs to the trunk.

Some hip problems are due to trauma, while many other conditions are due to overuse or misuse. Muscle imbalance impairs the normal joint function, limiting the functional range of motion. Degenerative and pathological hip conditions can be challenging to diagnose. Many times, patients who complain of pain and discomfort in the lower back, the buttocks, or the legs can be traced to a hip condition. And conditions such as hernia or aneurysm, without an obvious hip connection, may also prompt pain in the hip or groin.

Often, hip disease manifests as pain in the groin radiating all around the thigh and the knee. In such cases, the real challenge is to ensure that the hip and thigh pain is a pathology of the hip, as opposed to intra-abdominal or retroperitoneal pain. The majority of hip conditions are related to biomechanical issues. For example, when a patient strains a knee, and has knee or ankle problems, the gait is affected, causing hip pain. A change in gait may include carrying a baby or small child on the hip. People may also complain of hip pain when they are sitting differently. Basically, asymmetry of motion can cause a hip problem.

Doctors of Chiropractic see many hip conditions develop over a period of time, such as trochanteric bursitis, recurrent muscle strains, Piriformis syndrome, and chronic degenerative changes in the hip joint (degenerative joint disease). Chiropractors have thorough knowledge of hip joint function, its involved muscles, and the adequate exercise regimen to help patients with hip problems.

The hip has many muscles attaching to it.  There is a very close relationship to the lower back vertebrae, sacro-iliac joint, knee and foot joints.

Biomechanically when there is hip pain of any kind the lower back, sacro-iliac, hip, knee and foot all need to be examined.

Different hip issues

Gentle stretching of specific muscle groups can be performed even right after an injury. Gradual movements of the joint should also be employed in order to prevent the formation of adhesions. In addition, vigorous exercise of the contralateral (opposite) leg muscles helps create a neurological stimulus in the injured muscles that offsets atrophy. In the case of an acute injury with muscle swelling, however, an initial period of rest may be needed.

Piriformis syndrome and trochanteric bursitis may benefit from specific stretching exercises. Piriformis syndrome develops when the piriformis muscle inflames the sciatic nerve, causing hip aches down the back of the leg. Treatment should include gentle stretches of the piriformis muscle.

Trochanteric bursitis brings pain to the lateral part of the hip. Localized pain in this area indicates the need for stretches to lengthen this segment of connective tissue.

Weakened or injured muscles can be strengthened with the use of isotonic resistance exercises from a machine, elastic tubing, weights, or the body's own weight.

Since biomechanical alignment issues are linked with chronic hip complaints, patients must be screened for leg-length discrepancies and pronation (flat feet) of the feet. The failure to address these factors may cause recurring hip complaints, or symptoms in other locations. The lower extremities must be properly aligned to ensure the hip joints work smoothly.  

Once the under-lying problems are identified advice can be offered to a patient that will allow them to start living a pain-free life! Many different options are available for treatment and as well for home therapy and changes to life style. These are on a case by case basis.

If hip issues are caught early the degenerative changes can be lessened and often avoided!

The hip is closely linked to the lower back, sacro-iliac joints and tailbone and is affected by knee and foot motion as well!

Piriformis Syndrome

The piriformis is a muscle that travels behind the hip joint. The piriformis muscle is small compared to other muscles around the hip and thigh, and it aids in external rotation (turning out) of the hip joint. The piriformis muscle and its tendon have an intimate relationship to the sciatic nerve--the largest nerve in the body--which supplies the lower extremities with motor and sensory function. The piriformis tendon and sciatic nerve cross each other behind the hip joint, in the deep buttock. Both structures are about one centimeter in diameter.

What do people think happens in piriformis syndrome?

It is thought that the piriformis muscle tendon may be tethering the sciatic nerve, and causing an irritation to the nerve. While it has not been proven, the theory supported by some physicians is that when the piriformis muscle and its tendon are too tight, the sciatic nerve is choked. This may decrease the blood flow to the nerve and irritate the nerve because of pressure. 

What else may be causing this pain?

Sometimes referred to as "deep buttock pain," other causes of this type of pain include: spine problems - including herniated discs, spinal stenosis, sciatica, and tendonitis. The diagnosis of piriformis syndrome is often given when all of these diagnoses are eliminated as possible causes of pain. 

Other signs of piriformis syndrome include examination manoeuvres that attempt to isolate the function of this muscle and the finding of pain directly over the tendon of the piriformis muscle. 

Is there treatment for piriformis syndrome? Yes!

Some treatment suggestions are: 

• Chiropractic adjustments – for the vertebrae, hips, and sacro-iliac joints
• Physical Therapy - Emphasis on stretching and strengthening the hip rotator muscles 
• Rest - Avoid the activities that cause symptoms for at least a few weeks 
• Anti-Inflammatory Medication - To decrease inflammation around the tendon 
• Active Release Technique – is very beneficial for the muscles, nerves, tendons, ligaments.
• Massage – A general Swedish massage is helpful
• Acupuncture – is very helpful for decreasing pain and promoting the healing response. Ask Dr. Barbara Rodwin about acupuncture
• Interferential current therapy – sends electrical impulses in to heal the muscle, decrease pain and reduce inflammation

There are many muscles in the hip! 

Bursitis of the hip

Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. This can be treated, ask us how!

Daily Activities to avoid ensuring that hip problems do not happen:

• Sitting on a wallet

• Carrying a child on your hip

• Sitting with your legs crossed at the knees

• Sleeping on your stomach

• Sleeping on your side without a pillow between the knees

• Driving with your foot rotated on the gas pedal

• Sitting at your desk without a foot stool

• Not using back support when sitting

Chiropractic Month

The Back to Health Wellness Centre will be celebrating Chiropractic Month for two months, starting on October 14th, 2014 until December 19th, 2014. 

During this time, any new patients will get to enjoy the utmost benefits, which includes a complimentary consultation, complete biomechanical-muscle-skeletal-neurological-orthopaedic-chiropractic exam and a food scan/gait analysis with a report of findings. This has a value of $75.

We will also be partaking in #StraightenUpCanada to celebrate #WorldSpineDay, which is on October 16th. 

We are challenging everyone to download the Straighten Up App and to complete a 30 day challenge of taking 3 minutes a day to do the exercises in the app! You could also take Selfies of yourself as well, before and/or after if you would like. 

We will be having three contests with prizes: one for the individuals who completes the 30 days performing the exercises in the Straighten up app, one for the selfies and the last for the individuals that completes both the app challenge and the selfies.

All the challenge takes is 30 days from October 14th until December 19th to complete the challenge!

Straighten Up App

STRAIGHTEN UP CHALLENGE and SELFIES!

What is the Straighten Up Canada app? Straighten Up Canada is a mobile app for improving posture and spinal health through twelve short exercise videos. Spend just three minutes a day doing these exercises and you'll be well on your way to better spinal health!

The app can be found at: www.straightenupcanada.ca.

We are challenging everyone to download the app and to complete the app challenge for 30 days starting on October 14th until December 19th. The app challenge is a 30 day challenge of taking 3 minutes a day to do the exercises in the app! As well you could take Selfies, before and/or after if you like of yourself.

We will be having three contests with prizes: one for the individuals who completes the 30 days performing the exercises in the Straighten up app, one for the selfies and the last for the individuals that complete both the app challenge and the selfies.

Stay tuned for the list of prizes!

Download your app now and try it out!

Biomechanics & Orthotics

 Your feet are the foundation of your body

People sometimes wonder how orthotics can correct knee or hip problems. Have you ever had a blister on the bottom of your foot? If you have, you know that you try to avoid putting pressure on it. You change the angle of your foot when you walk and the next thing you know, your knee or hip hurts because you’re walking differently.

Why do people have problems with their feet? It’s simple. The foot is always in motion and under enormous pressure from the body’s weight. As we walk or run, our entire weight lands on our feet, up to 10,000 times a day.

Or, you may have a sore back or hip, and when you alter the way you walk to compensate, your feet begin to hurt. There are many reasons for the aches in the back, legs, and feet  – accidental trauma, poorly fitting shoes, or simply signs of age. That’s why people whose feet or legs are not “biomechanically correct” or in perfect alignment, often experience pain in other parts of the body.

Remember, your feet are your foundation. Footmaxx orthotics correct the movement of the foot, and that relieves the problems in the legs, hips and back.

FOOTMAXX ORTHOTICS
Footmaxx orthotics, which are the custom orthotics we use, fit into your shoes. They are similar to insoles, except that they are custom made just for you. These orthotics will correct and improve the way your feet strike the ground. They help your feet move effectively and enhance your natural movement.

Until a few years ago, many orthotics were bulky and that meant people sometimes had to buy special shoes. Not anymore!!! The new Footmaxx orthotics are very thin and lightweight. They fit easily and discreetly into your existing shoes. You can wear your most stylish form-fitting shoes, and still get the proper support and correction from Footmaxx orthotics. They have even come out with orthotics specific for most sports. They have them for hockey, figure skating, skiing, golfing, basketball, baseball, and numerous other sports. Also they have an arthritic and diabetic line of orthotics.

You can learn more about them at www.Footmaxx.com, email Keri-Lyn@Back2Health4you.com or book an appointment with Keri-Lyn.

Biomechanics - the physics of movement

We live in an environment that forces our bodies to react to gravitational forces. With every step we take, our skeleton's alignment and structure influence the process of absorbing and releasing the energy that motion and gravity create. Our feet are highly adaptable. As they hit the ground and begin to absorb load, the motion they undergo is called pronation.

The flexibility of our joints deter-mines how much energy the lower extremity chain (foot-ankle-knee-hip-pelvis-low back) can absorb. For different reasons, both flat and high-arched feet channel a large amount of energy to skeletal structures high in this chain — especially the knee and the hip—making those structures more susceptible to injury

For example, it is common for the kneecap (patella) to develop pain because a flat foot forces the patello-femoral joint to absorb more energy. Running sports add 'impact loading' to the equation. Running and jumping amplify the effects of failed biomechanics. Sprains and strains are likely to occur when joints are poorly aligned or when they absorb forces that should be directed to another part of the body.

How Our Feet Work
Your foot is made up of 26 bones that function as a mobile adapter, then as a shock absorber for the rest of your body. During the mobile adapter phase of walking or running, the foot is a "loose bag of bones" that can be placed on any surface and still help maintain the equilibrium of your leg and body above. As adaptable as your foot's structure must be, it must also be capable of locking itself into a rigid structure so that it can act as a lever, first to stabilize and lift your body's weight and then to propel it forward.

Why Does The Chiropractor Check Your Feet When Your Back Hurts?

The joints and muscles to the body function most efficiently when they are in physical balance. The body is a biomechanical chain where abnormal movements at one link, or joint, can interfere with proper movements at other joints.

When foot imbalance is present, there is a negative impact on the knees, hips and pelvis, and spine.
Improper balance and function of the feet can lead to a variety of conditions including: excessive rotation of the leg bones stressing the knee and twisting the pelvis and spine.
• Excessive rotation of the leg bones stressing the knee and twisting the pelvis and spine.
• Tilting of the pelvis which places tension on muscles and connective tissue, eventually resulting in chronic back problems.
• High levels of heel-strike shock from breakdown of the body's natural 'shock absorbers.' The shock wave then transmits up the kinetic chain, resulting in painful symptoms up to the head, slowed recovery of leg and spine injuries, and aggravation of other conditions