Back pain information for a better understanding of causes and treatment.

Back pain is something that happens to most people at some point in their lives.  We see all sorts of injuries but one of the most common things we hear at DoroskiChiropractic Neurology in Woodbridge VA is "I didn't do anything."  In quite a few instances you didn't do anything, at that time.  It was all the stuff you did a month prior that created an environment where a sneeze caused the entire thing to fall apart.  That is where seeing a chiropractor on a regular basis helps, because you can keep making small corrections to your back to prevent the flare ups.

Back pain is very common and is treatable but it does require some regular maintenance once you have had your second or third injury.  Your back is made up of small joints held together by muscles and ligaments.  Once you sprain (stretch) the ligaments they become loose and even after they heal they are not as tight as before.  A good analogy I use with patients is a twisted ankle.  The first time you twist your ankle you did something.  You stepped in a hole, jumped and landed on it wrong…. Something!  The next time you did it you did something just not as traumatic.  Maybe you step off the curb funny.  The third time you are tying your shoe.  By the fourth time you woke up and your ankle hurts and you limp on it for a week trying to figure out what happened.  Your back is the same way but with many more moving parts that can cause the same stress and same pain.  That is why maintenance after your second or third time is necessary to prevent flare-ups.  Here are the ACA statistics about back pain.

Back Pain Facts & Statistics

Although chiropractors care for more than just back pain, many patients visit chiropractors looking for relief from this pervasive condition.  In fact, 31 million Americans experience low-back pain at any given time.1

A few interesting facts about back pain:

Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.

One-half of all working Americans admit to having back pain symptoms each year.2

Back pain is one of the most common reasons for missed work.  In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.

Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.3

Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives.4

What Causes Back Pain?

The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Manipulation as a Treatment for Back Problems

Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today's growing emphasis on treatment and cost effectiveness, manipulation is receiving more widespread attention.

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5

In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. And it recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.6

A patient information article published recently in the Journal of the American Medical Association also suggested chiropractic care as an option for people suffering from low back pain--and noted that surgery is usually not needed and should only be tried if other therapies fail.7

The American Chiropractic Association (ACA) urges you to make an informed choice about your back care. To learn more about how the services of doctors of chiropractic may help you, review the results of recent research studies and contact a Doctor of Chiropractic in your area. Search our online database of ACA members to find a doctor of chiropractic near you.

Tips to Prevent Back Pain

Maintain a healthy diet and weight.

Remain active—under the supervision of your doctor of chiropractic.

Avoid prolonged inactivity or bed rest.

Warm up or stretch before exercising or other physical activities, such as gardening.

Maintain proper posture.

Wear comfortable, low-heeled shoes.

Sleep on a mattress of medium firmness to minimize any curve in your spine.

 Lift with your knees, keep the object close to your body, and do not twist when lifting.

Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.

Work with your doctor of chiropractic to ensure that your computer workstation is ergonomically correct.

References:

1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.

2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.

3. This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville,

4. In Vallfors B, previously cited.

5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.

6. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.

7. Goodman D, Burke A, Livingston E. Low Back Pain. JAMA. 2013; 309(16):1738.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Should you really trust that lumbar support.

We hear it all the time at Doroski Chiropractic Neurology in Woodbridge VA… “Don’t worry Doc I have a back brace I wear while I am at work.”  Just because you are wearing one doesn’t mean you are free from harming your back and does wearing one incorrectly even help.   No one really thinks about wearing one correctly you figure it is a belt how can I do it wrong.  Well I can tell you from personal experience you can do a lot of things wrong that you figured there really is only one way to do it.  Take running for example.  A few years ago I got in to running and figured I have been doing this for years “I think I got this.”  It always feels good busting your butt getting ready for your first half marathon and at mile two the person you signed up to do it with, but never ran with, who happens to be a track coach goes “wow you are doing it wrong.”  I bet after each run your shins are killing you and your back is tight.  Why yes it is.  Yea try doing this this and this.  Next thing you know you are running easier and faster.  So trust me just being handed a back brace doesn’t mean “you got this.” 

So let me give you some background on back braces and do they really help.

The truth is that wearing an elastic or other support around your waist to help your back may be both good and bad.  And whether wearing such a back belt will prevent back problems is controversial.  A new study that found workers who routinely wear these support belts while working at Wal-Mart, were just as likely to injure their backs as those who did not.(1)  However, some previous studies have shown back belts to prevent injuries, such as the UCLA study conducted with Home Depot workers, which found a 1/3 decrease in back injuries due to wearing back belts.(2)

Let’s look at the scientific evidence about whether back belts might help to support the back, whether there are any risks associated with wearing them, and whether such belts should be recommended or not. 

 

How might back belts help to support the back?  They do not hold the back in, as many presume. Back belts function primarily to hold the stomach in, thus increasing intra-abdominal pressure.  This has led some to refer to these belts as abdominal belts rather than as back belts.  But how does increasing intra-abdominal pressure support the spine?  We will briefly review the intra-abdominal balloon theory and a more modern theory.

Intra-Abdominal Balloon Mechanism

It was originally proposed by Bartelink in 1957 that increased intra-abdominal pressure would decrease the compressive load on the spine through the intra-abdominal balloon mechanism.(3)  To begin with, you must think of the abdominal cavity and the abdominal organs as a squishy liquid.  Then realize that the abdominal cavity becomes a closed chamber when we bear down and hold our breath, which we instinctively do when we lift heavy things.  This chamber is closed on the bottom by the anal sphincter and on the top by the diaphragm.  When bearing down, the abdominal contents tend to push outwards.  But if we contract our deep abdominal muscles—the obliques and the transverse abdominus muscles—or we wear a thick belt, the abdominal contents are forced upwards rather than outwards.(4 p.109)  This theoretically provides a decompressive effect on the lumbar spine.  Since the crura of the diaphragm is attached to the first 3 lumbar vertebrae, when the diaphragm is pushed upwards, it exerts a traction force on the lower lumbar spine (L4 and L5).  It was also theorized that since this balloon mechanism makes the spine more rigid, it would decrease the amount of work required of the erector muscles to prevent us from falling forwards.   Kapanji estimated that this abdominal support mechanism acts to reduce compression forces on the L5/S1 disc by 30% and reduces the force required by the erector spinae muscles by 55%. (4, p.198).

But more recent scientific evidence fails to support some of these theoretical assumptions.  Such recent studies reveal that an increase in intra-abdominal pressure actually results in an increase (rather than a decrease) in compressive force on the lower spine.(5,6) And there is no decrease in the amount of work required of the lower back muscles.(7)  However, by stiffening the trunk, increased intra-abdominal pressure may prevent the tissues in the spine from strain or failure from buckling.  Such intra-abdominal pressure may also act to reduce anterior-posterior shear loads.(8)  In other words, support for the spine is provided, without reducing compression to any appreciable degree.

Belts may also help to protect the spine by limiting the range of motion that occurs when bending or twisting, though this effect is less than expected.(9,10)  However, since when the spine bends more, it is more vulnerable to injury, if these belts reduce extreme bending at all, they may be beneficial.

Are there any risks associated with wearing a back belt?

The main risk associated with wearing a back belt is that during the period of wearing it, the supportive spinal muscles—the deep abdominal and back muscles—that normally support your spine will become weaker.  These muscles are less active while your spine is being artificially supported by the belt.  Muscles need to be consistently exercised in order to stay strong.  If these muscles become weaker, when you stop wearing the belt, you may be more likely to hurt your back.  And at least one study seems to suggest this.  In this study, there was an increase in the number and severity of back injuries following a period of belt wearing.(11)

Another risk associated with wearing a back belt is that it causes an increase in both blood pressure and heart rate.(12)  This may pose a problem for those individuals with existing cardiovascular disease or risk factors, such as hypertension.

A third risk associated with wearing a back belt is that workers may be inclined to lift heavier objects while wearing them.  These belts may be giving workers a false sense of security.  This could result in an increased risk of injury.   

REFERENCES:

Wassell JT, Gardner LI, Landsittel DP, Johnston JJ, Johnston JM.   A prospective study of back belts for prevention of back pain and injury.  JAMA.  2000; 284(21): 2727-32.

McIntyre DR; Bolte KM; Pope MH. Study provides new evidence of back belts' effectiveness. Occup Health Saf.  1996; 65(12): 39-41.

Bartelink DL, "The Role of Abdominal Pressure in Relieving Pressure on the Lumbar Intervertebral Discs," J Bone Joint Surg, (Br) 1957, 39B: 718-725.

Kapanji, IA. The Physiology of the Joints, Vol. III.  

McGill SM, Norman RW.  Reassessment of the role of intra-abdominal pressure in spinal compression.    Ergonomics. 1987; 30: 1565-1588.

Nachemson AL, Anderson GBJ, Schultz AB. Valsalva maneuver biomechanics. Effects on lumbar spine trunk loads  of elevated intrabdominal pressures. Spine. 1986; 11: 476-479.

McGill S, Norman RW, Sharatt MT. The effect of an abdominal belt on trunk muscle activity and intra-abdominal pressure during squat lifts. Ergonomics. 1990; 33:147-160.

McGill S. Abdominal belts in industry: A position paper on their assets, liabilities and use. Am Ind. Hyg. Assoc. J. 1993; 54(12): 752-754.

Lantz SA, Schultz AB. Lumbar spine orthosis wearing I. Restriction of gross body motion. Spine. 1986; 11: 834-837.

McGill SM, Sequin JP, Bennett G. Passive stiffness of the lumbar torso in flexion, extension, lateral bend and axial twist: The effect of belt wearing and breath holding. Spine. 1994; 19(19): 2190-2196.

Reddell CR, Congleton JJ, Huchinson RD, Mongomery JF. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers. Appl. Ergonomics. 1992; 23: 319-329.

Hunter GR, McGuirk J, Mitrano N, et al. The effects of a weight training belt on blood pressure during exercise. J Appl Sport Sci Res. 1989; 3: 13-18.

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Woodbridge VA 22192

703 730 9588

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Neck pain first thing in the morning!

I just woke up this morning and now I can't turn my head.  This is very common at Doroski Chiropractic in Woodbridge VA.   It has many names some I can't say here but the most common is a "crook in the neck."  

Well if that is the case don't you wish the crook would just  steal something and leave you alone!  But no… it hangs out and annoys you and can eventually make your arm tingle.  The cause is usually the levator scapulae muscle.  

Most of the time it wasn't the sleeping that screwed it up it is the continually tightening of that muscle over the last couple of months.  The tightening occurs from bad postures, improper chair adjustment or repetitive movements.  Your body is great at conserving energy so if you are going to hold that right shoulder up to use the mouse all day or hold that left shoulder up pinning your phone between your ear and shoulder for long periods so you can still use your hands, your body is going to put adhesion in the muscle to shorten it so that position doesn't cost you energy.  That is the great thing about your body if you are going to do something over and over it takes short cuts to conserve energy.

If you can’t get to your chiropractor here is a safe stretch you can do at home that may help short term.  Start with a hot shower to warm the muscle up.

The muscle runs from the top medial part of your shoulder blade up in to your neck.  So the way to stretch it is to separate those two structures.  You can do the stretch standing or sitting.

1.  Lengthen the muscle by raising the elbow above the shoulder on the side to stretch.

2.  In this position, first rest the elbow against a door jamb. This rotates the outside of shoulder blade up and the inside of it down, which lengthens the levator scapula muscle.

3.  Second, turn the head away from the side that is stretching and bring the chin down, stretching the back of the neck .

4.  Third, place the fingers of the other hand on the top of the head and gently pull the head forward increasing the stretch slightly.

Hold this for about 30 seconds to a minute.

If this helps great you got some relief before going to your chiropractor.  If they didn't help call for an appointment because it won’t usually improve on its own.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Neck pain that travels into your upper arm may not be a disc injury

Neck pain that shoots in to the arm is more common than you think.  Doroski Chiropractic Neurology in Woodbridge VA sees it on a weekly basis.  The good news is it can be fixed sometimes without surgery. 

Pain into the arm or shoulder area with associated neck pain may not be the dreaded disk injury everyone is afraid of.  It could be an injury called thoracic outlet syndrome.  It sounds scary but it is quite common and can be fixed with the proper non-surgical treatments.  At Doroski Chiropractic Neurology we can quickly and properly diagnose this injury

The thoracic outlet is a passageway for the nerves and blood vessels into your arm.  It is located in the upper chest area.  It is made of a boney and muscular opening.  So anything that causes anyone of those structures to become enlarged can compromise the opening.  The most common and most treatable is a muscle spasm that caused the muscle to swell.

If this is the case most patients complain of the neck and upper arm pain but they also have a very sharp at the top medial corner of their shoulder blade.  This is the attachement of the Levator Scapulae muscle.  This muscle also passes behind the thoracic outlet area and it can swell pushing into the opening and compressing a nerve.

Since we are not hollow creatures everything is touching everything.  So a spasm of the neck support musculature can push the tissue forward which then pushes in to the opening.  This spasm is most notable by neck pain and upper shoulder blade pain.  It can be associated with pain in the neck and arm when turning the head towards the side of the pain.  Sometimes turning away from the painful side can actually decrease the neck pain and the referral. 

A chiropractor can diagnose this injury from a disk injury and apply the proper treatment.  The treatment usually involves heat, electrical stimulation, stretching and trigger point therapy.  Once the muscle is relaxed manipulation of the spine can also help.

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3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Low back pain and Neck pain and your office chair... how are they related?

Low back pain and neck pain can be prevented by properly adjusting your office chair.   At Doroski Chiropractic Neurology in Woodbridge VA we see tons of people complaining of back pain.  Most of them sit in improperly adjusted chairs.  These tips should help you prevent some general low back issues that lots of people experience.  Visit us at Doroskichiropractic.com for other blog tips and to schedule an appointment.

The first step in setting up an office chair is to establish the desired height of the individual’s desk or workstation. This decision is determined primarily by the type of work to be done and by the height of the person using the office chair. The height of the desk or workstation itself can vary greatly and will require different positioning of the office chair, or a different type of ergonomic chair altogether.

Once the workstation has been situated, then the user can adjust the office chair according to his or her physical proportions. Here are the most important guidelines - distilled into a quick checklist - to help make sure that the office chair and work area are as comfortable as possible and will cause the least amount of stress to the spine:

Elbow measure

First, begin by sitting comfortably as close as possible to your desk so that your upper arms are parallel to your spine. Rest your hands on your work surface (e.g. desktop, computer keyboard). If your elbows are not at a 90-degree angle, adjust your office chair height either up or down.

Thigh measure

Check that you can easily slide your fingers under your thigh at the leading edge of the office chair. If it is too tight, you need to prop your feet up with an adjustable footrest. If you are unusually tall and there is more than a finger width between your thigh and the chair, you need to raise the desk or work surface so that you can raise the height of your office chair.

Calf measure

With your bottom pushed against the chair back, try to pass your clenched fist between the back of your calf and the front of your office chair. If you can’t do that easily, then the office chair is too deep. You will need to adjust the backrest forward, insert a low back support (such as a lumbar support cushion, a pillow or rolled up towel), or get a new office chair.

Low back support

Your bottom should be pressed against the back of your chair, and there should be a cushion that causes your lower back to arch slightly so that you don’t slump forward or slouch down in the chair as you tire over time. This low back support in the office chair is essential to minimize the load (strain) on your back. Never slump or slouch forward in the office chair, as that places extra stress on the structures in the low back, and in particular, on the lumbar discs.

Resting eye level

Close your eyes while sitting comfortably with your head facing forward. Slowly open your eyes. Your gaze should be aimed at the center of your computer screen. If your computer screen is higher or lower than your gaze, you need to either raise or lower it to reduce strain on the upper spine.

Armrest

Adjust the armrest of the office chair so that it just slightly lifts your arms at the shoulders. Use of an armrest on your office chair is important to take some of the strain off your upper spine and shoulders, and it should make you less likely to slouch forward in your chair.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Low back pain prevention tips

Low Back Pain prevention tips given by Doroski Chiropractic Neurology in Woodbridge VA.  These tips should help you prevent some general low back issues that lots of people experience.  Visit us at Doroskichiropractic.com for other blog tips and to schedule an appointment.

Low back pain is very common and I see it all the time in my office.  One of the common things I hear is something completely benign caused it.  Granted we see a lot of traumatic injuries that you would assume would cause low back pain.  Digging a hole, falling off the roof, working doing repetitive twisting… and on and on.  The ones that catch the patient off guard is sneezing, reaching in the back seat of the car, bending to pick something off the floor. ..  These are the injuries that always make the patient scratch their head.  Unfortunately, it is not the event that really caused the injury.  It is the 4 weeks of back stiffness that they ignored before the injury.  Usually when I ask they go yea it was stiff, or yea I just had a long car ride, or I put in new baseboards BUT it was ok after that.  Odds are it really wasn’t but you were just dealing with it. 

When your low back is tight for a long period of time it is a ticking time bomb.  The muscles are continually pulling on the pelvis and lumbar joints until that one weird movement and the entire thing falls apart.  Unfortunately, this injury is harder to fix then the guy who fell off the roof, mainly because the rest of his back hasn't had a few weeks to compensate for the low back tightness. 

Here are some daily stretches you can do to keep your back stretched and relaxed so the muscles function correctly.

1. Knee to Chest

Lie on your back, flex your knees up and do a pelvic tilt so you press your lower back flat to the floor.  Slowly and gently pull your right knee to your chest at a slight angle towards your left shoulder.  Hold for 5 seconds and release back to the bent position.  Then repeat with the opposite leg.  Do this 10 times in alternating fashion.

2. The Deep Squat

Stand up straight with your arms folded across your chest. Place your feet shoulder-width apart and toes pointing out slightly.  Squat down as far as you can, keeping your heels on the floor. As you squat ensure your weight goes into your heels and not your toes. For a full range of movement, your bum should sit down by your heels and your head should be tall and looking forward. Perform the exercise slowly when lowering down, giving yourself time to keep control and lower all the way – or as far as your range of movement will allow.  Pause for a count of two at the bottom of the squat, allowing your groin area to relax. Your knees should be directed slightly outwards in alignment with your feet. Keeping your knees out, squeeze your gluteals and stand up out of the squat.  Only go as far as you can without any pain. As you perform the exercise regularly you will slowly but surely be able to achieve greater flexibility.  Do this for 2 sets of 10.

3. Downward Dog

Place your hands and feet on the floor, shoulder-width apart, knees bent and hips high.  Your heels should be off the floor at this point. Relax your head and neck so you are looking towards your knees.  Do a pelvic tilt so your lower back is arched and your spine is straight.  Now straighten your arms and pull your shoulder blades together. Straighten your knees as well.    You may lose the arch in your low back but don’t allow your lumbar spine to flex.  This will require a good abdominal squeeze to maintain the lumbar arch.  Hold for 30 seconds and relax.  Repeat 5 times. 

4. Spine twists

Sit down with your legs loosely crossed. Pull your back up tall and stick your chest out so that you are sitting upright with perfect posture. Fold your arms across your chest.  Tighten your abs so that your pelvis is stable. Then slowly turn your head and shoulders to one side. Turn as far as you can and you will feel the stretch in the rib area. Hold the end position for a count of two and then turn across to the other side and repeat.  Perform two sets of 10 repetitions each side.

Do not force any of these exercises and if you feel any discomfort stop.  Keeping your low back stretched will help you prevent some low back injuries but routine chiropractic visits with these stretches can help prevent the big injuries.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Easy tips to avoid neck pain!

Tips given by Doroski Chiropractic Neurology in Woodbridge VA.  Dr Doroski is the only Chiropractor in Woodbridge Virginia with a diplomate in Chiropractic Neurology.

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If you have neck pain sometimes the easiest thing you can do to fix it is visit us at Doroski Chiropractic in Woodbridge Va.  Once here we can help you with most neck complaints and give you some good ideas on how to avoid it in the future.  Some are very easy, some are just commonsense and others just involve regular follow through.  

Proper neck posture, a simple matter of good body mechanics, can offer you protection from neck pain. Here are suggestions from the American Academy of Physical Medicine and Rehabilitation and other experts that can help prevent the misuse or overuse of your neck:

Don't sit in 1 place for a long time. If you're stuck at your desk, place items around your office so that you are forced to get up or stretch to retrieve them.

Maintain good posture for your neck. Adjust your desk chair so your hips are slightly higher than your knees. Your head and neck will then naturally assume the correct position. When traveling, place a small pillow or rolled up towel between your neck and the headrest.

Don't sleep with too many pillows or with a pillow that's too thick.

When talking on the phone, don't cradle the phone between head and shoulder. If you're on the phone often, switch to a headset or speakerphone.

If you are reading or typing from other materials, raise the pages to eye level.

If you have corrected vision, keep your prescription current so you don't have to crane your neck forward to see clearly.

These are fairly generic tips but if you use them on a daily basis you can prevent most of the neck complaints we see in our office on a daily basis!

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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