The Lower Back

THE ANATOMY OF THE LOWER BACK
The lumbar spine is made up of 5 vertebrae. Below the lumbar region are 5 fused vertebrae of the sacrum and the 5 fused vertebrae of the coccyx. A facet joint joins each pair of vertebra (i.e., the one above to the one below). Like hinges, the facet joints guide the movement of the spine, while also stabilizing the vertebral column.  

Ideally, the joints in the spine are lined up so that the back can twist and bend with little friction between the vertebrae. Between each pair of vertebrae lies a flat, circular inter-vertebral disc. The outer part of the disc, the annulus, is strong and hard. The inner portion, the nucleus pulposus is soft and absorbs shocks to the spine during movement. Many times degenerative disc disease or other problems involving the disc can lead to unbearable back pain. This can be due to damage to the nerve. 

The vertebrae surround and protect the spinal cord, a column of nerves running down from the brain. Nerves branch off from the spinal cord and with their roots passing through the vertebrae, extend all over the body. As a result, pain from a back problem may also travel to other parts of the body. This can cause numbness, tingling, pain, burning into the hips, legs, knees, feet, and even around to the abdominal region! One example is Sciatica.

CORE EXERCISES

Core exercises are excellent for aiding with problems of the lower back. Unfortunately they can cause issues with the lower back as well, if not performed properly and not the right type! People often will make use of the psoas muscle, hip flexor, too much and they also use the lower back joints when doing core – which places pressure on the spinal segments. Studies have indicated that people are aggravating their back when performing core exercises

The abdominal muscles can be engaged when sitting, standing, walking and running. If you think about placing your lower back/hips in ‘neutral’ alignment you are able to activate your core properly in these postures. Just think while doing any of these activities you can be working your core!

Please see the front bulletin board for instructions on how to obtain this neutral alignment! You can also ask Dr. Barbara Rodwin how to do this.

The lower back – the muscle (in red) is the psoas

SITTING CAN CAUSE LOWER BACK PROBLEMS

As technology advances, we are spending more and more time sitting, often in front of a computer. People are also being less and less active. Sitting all the time wreaks havoc on your posture and can cause pain, stiffness and discomfort in the lower back, hips, and neck.

Sitting all the time can add excessive compression on the joints of the lower back. Many people think that sitting is better for the lower back than standing, but sometimes sitting can be worse than standing. When you sit down, all of your upper body weight is supported by your pelvis and lower back. However, if you are standing, the weight of your upper body is supported by your pelvis, lower back, hips, knees, and ankles.

Standing and sitting can both put pressure on the lower back but through slightly different mechanisms. In standing, if you have poor posture or poor core stability you may feel discomfort in your lower back, but sitting (especially with bad posture on a hard surface) will put more pressure on the joints of the lower back.

We do have a posture sheet explaining how to use your chair and sit properly!

LOWER BACK PROBLEMS

Lower back pain means relatively short-term pain, stiffness and/or muscle tension anywhere along the back, starting below the ribs and extending to just underneath the buttocks.  If you are having lower back issues it is important that you have it examined by a Doctor of Chiropractic. A biomechanical exam will be performed which will determine if the problem is a lower back vertebrae/joint, muscle, and/or disc issues. Also we will determine if it is due to sitting, standing, lifting, walking, running, and/or sleeping habits.  

During the course of the day if we use our back, abdominal, hip and trunk area properly we place very little pressure/stress on this region. If we are not using this area properly studies have indicated that we can put upwards of 150% greater force on the lower back. This extra force will over time lead to fatigue of the back and can cause spinal degeneration/arthritis in the lower back due to the repetitive stress placed on the vertebrae.  

When this degeneration occurs to the vertebrae and discs this causes the lower back vertebrae to lose some of their normal motion. Our body then adapts by tensing the muscles to hold this area tighter. This will lead to stiffness in the long back muscles, also known as the erector spinae. You will feel this along the sides of the spine. All of this can then cause issues with the nerves that exit at each vertebrae.

Lumbar degeneration 

LUMBAR VERTEBRAE, NERVES, DISCS, JOINTS 

Some people with lower back problems then feel it in their buttocks, backs of their legs, into their thighs, knees, shins and even into their feet!

As you can tell the lower back is very complex and involves many structures that can cause your lower back discomfort.

Arthritis

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The word Arthritis means inflammation of the joint and loss of joint motion. Arthritis can affect a person at any age.

Arthritis is most likely to appear in the following forms: Osteoarthritis (abnormal wear and tear type, from injuries and use), Degenerative joint disease (DJD), Rheumatoid Arthritis, Lupus, Fibromyalgia, Gout and Juvenile arthritis.

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Eight classes of classes of arthritis and related conditions have been identified. These are: 

• Inflammatory Arthritis - The membrane of the joint becomes irritated
• Attachment arthritis - frequently in the heel or lower back, the ligament or tendon fastened to the bone becomes irritated
• Crystal arthritis - the big toe has deposits of microscopic crystals of sodium urate
• Joint infection - bacteria contaminate the fluid inside the joint, usually found in the hip, shoulder and knee
• Cartilage degeneration - usually found in the knees, neck, back, hips, fingers, toes, wrists and feet, this type of arthritis arises when the cartilage of the joint breaks down
• Muscle inflammation - muscle tissues become inflamed
• Local condition - a local injury causes pain, such as tennis elbow, runners knee, etc.
• General conditions - a condition characterized by generalized muscle pain and sleep disturbances.

Massage therapy for arthritis
Although massage therapy cannot cure or stop the progression of arthritis, it can ease the symptoms associated with inflammation and improve quality of life. While the cartilage damage of arthritis cannot be reversed, massage is helpful in reducing muscle spasms and decreasing compression associated with the arthritic joint disorder. The benefits of massage include: Increased circulation, Increased flexibility and mobility, Decreased pain and inflammation, Relief of muscle aches and stiffness and, an overall sense of relaxation and wellness.

A variety of massage styles can help decrease arthritis pain. Swedish massage therapy is the most relaxing and is used to stimulate blood flow to the skin and relax the muscles. Deep-tissue massage therapy can decrease pain and improve movement in specific muscles and joints. Active release can aid in reducing the
scar tissue.

Special points of interest:

• Did you know that we treat all forms of arthritis?
• We have an infor-mation sheet on nu-tritional supple-ments for arthritis.
• We have an Arthritic line of Custom Orthotics

Chiropractic and acupuncture

Dr. Barbara Rodwin has been treating all types of arthritis! When a person has arthritis they lose motion in the joint that the arthritis is associated with. The joint then loses mobility, the cartilage may decrease and then the stiffness, discomfort and pain ensues!

All joints of the body—the jaw, neck, shoulders, elbows, wrists, fingers, back, hip, knees, ankles, toes can be adjusted to then allow the movement of the joint to improve.

Over her years of practice, Dr. Rodwin, has been able to aid countless patients in improving their mobility!

She has specialized treatment types to help in re-storing motion to the joints which is safe, pain-free and affective!

Often patients are advised on proper sleeping, sitting, exercise, stretches and nutrition that helps with the arthritic condition.

Dependant on the type and extent of arthritis sometimes acupuncture is incorporated into the treatment to aid in resolving pain and restoring joint function. Studies have been completed to show that acupuncture is effective with arthritis. Please see the binder in front reception which highlights these studies.

Tension headache or migraine? – Knowing the difference

Have a headache again? Do you find they have been coming on more frequently lately? Not sure of the best way to manage the symptoms, or even where they come from? If you’re asking yourself these questions then you’re not alone. It’s good to be aware of the difference between headache pain and migraine pain. Being able to differentiate your pain symptoms will help you to manage them better and be aware of possible triggers in the future.

There are usually two main reasons we get headaches. One is a direct symptom from an underlying cause, such as muscle tension, sleep disturbances, or maybe even posture or jaw imbalances. The second is usually a side effect from something more systemic going on, like the flu or a form of injury or trauma. We will be focusing on the primary headache or migraine symptoms and how to be aware of them.

What is the difference between a tension headache and a migraine? It’s the way you experience them and the types of pain or symptoms that you have that will define one or the other.

Headache pain is usually a dull throb or ache that happens on one or both sides of our temples, the back of our head, or even the bridge of our nose. Tension around our shoulders and neck (or even slight nausea) can also sometimes accompany a headache, but usually most symptoms will either decrease or go away all together in a time span of 30 minutes to 15 days, depending on the severity.[i] These tension headaches can be caused by stress, imbalanced postures or positioning for too long, muscle or joint restriction or even changes in temperatures outside.

The best way to alleviate these symptoms is first to rest as much as possible. Having a hot bath with a cold damp face cloth applied to either the forehead or neck can also help to ease headache symptoms. Adjusting your pillow or sleep patterns, or even taking more short rest breaks at work can help to make headaches less frequent. Having a massage or a chiropractic adjustment and talking with your health care provider about proper stretches and posture to alleviate muscles can also be very beneficial if you have a headache.

Migraines, in comparison, have very different symptoms and can be more debilitating. It is believed that migraines originate from a mix of vascular and neural tension which can be triggered by diet, stress, hormonal shifts, allergies, hunger and a lot of other causes. Early symptoms may occur that can indicate a migraine is about to start, like water retention, an increase in fatigue, or general malaise. Once a migraine has started symptoms are usually severe and can last between 48 to 72 hours. When a person is suffering from a migraine, some symptoms that may occur are muscle soreness, sensitivity to light and sound, nausea or vomiting, and cold sweats. Some symptoms may affect vision, causing a blurry aura around objects (depending on the severity of the migraine).

The best way to take care of a migraine is to stop it before it even begins.  Be aware of what triggers may cause your migraine symptoms to appear, and if possible eliminate or reduce the stress to your body in those areas. If you start to feel a migraine come on, hot baths and self massage can help to decrease the symptoms. During a migraine, however, it is best to rest as much as possible in a dark room with a cold gel pack applied to the head or the back of the neck. Eating lighter but regular meals and staying hydrated is also an important form of self care. Once the migraine has passed it is always a good idea to get a massage or chiropractic adjustment to alleviate any lingering tension that may have occurred from the migraine.

If you notice that your headaches or migraines are more frequent, last longer, and are becoming more severe and painful, it is always recommended to seek advice from a medical expert or your MD. There may be underlying health conditions that could be causing your headaches.

Headaches or migraines are sometimes unavoidable but how you respond to them is up to you. Don’t let your headaches or migraines interfere any more than you need to. Get back to the things you love and to a healthier you. You’ll be glad you did.

Article by: Ashley Rocheleau - Registered Massage Therapist 

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[i] References from Clinical Massage Therapy – Rattray, Ludwid 2000

Success Stories of ART

I developed a nasty case of tennis elbow after a busy weekend of skiing and playing shinny hockey (a sport I had never played in my life but why not now)? After about three weekends during which I could hardly lift my coffee cup, let alone do any chores around the house and forget strength training in my aerobics classes, I decided that it was time to seek help.

Dr. Rodwin was very thorough in her assessment and suggested that I try Active Release Technique. Apparently, my arm and shoulder muscles were quite tight and there was plenty of scar tissue there, which probably led to the stress on the ligaments at the elbow.

Initially, I found the treatments somewhat uncomfortable, and I did experience some tenderness afterward, but Dr. Rodwin was always careful not to give me more than I could tolerate. Within weeks my elbow pain started to go away. Before I knew it, my coffee cup was not a painful lift and I began to resume strength training in my fitness classes.

For several years, though I am quite physically active, I have suffered from muscle pain and muscle spasms that were actually quite extraordinary for a person at my fitness level. I had complained to my doctors many times about it, but to no avail. My potassium levels were normal and no one could figure it out (I wondered if anyone really cared, as I did continue with my active lifestyle in spite of the discomfort and pain). It was becoming impossible to stretch many of my muscles because of tightness and/or cramping. The result of not being able to stretch made the muscles even tighter which was causing more pain in my back and other joints as well. I was afraid that I had some serious illness.

The ART treatments in the lower body were somewhat uncomfortable at the beginning and I did experience bruising which Dr. Rodwin had mentioned was a possibility. She was always accommodating when the bruises were too sore for a treatment. But, the payoff was huge!

I had not had a good run in five years: my left leg had ached every step of the way to the point of my foot dropping and causing me to trip. The pain and foot drop have disappeared! I actually look forward to my runs now, where I was about to give up running completely. I can get out of bed in the morning almost pain free! I can stretch! I had almost given up some of these activities because they weren’t fun anymore. Now, I’m back and feeling great!